Provider Demographics
NPI:1760611974
Name:KANG, YOUNGMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNGMO
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GREENWICH ST
Mailing Address - Street 2:APT 1604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006
Mailing Address - Country:US
Mailing Address - Phone:201-953-4316
Mailing Address - Fax:
Practice Address - Street 1:88 GREENWICH ST
Practice Address - Street 2:APT 1604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2204
Practice Address - Country:US
Practice Address - Phone:201-953-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ239991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice