Provider Demographics
NPI:1770842460
Name:KANG SMITH, JUNG WOOK (MD)
Entity Type:Individual
Prefix:
First Name:JUNG WOOK
Middle Name:
Last Name:KANG SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUNG WOOK
Other - Middle Name:
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:270-844-8027
Mailing Address - Fax:270-844-8183
Practice Address - Street 1:520 MARY ST STE 340
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1679
Practice Address - Country:US
Practice Address - Phone:812-450-6700
Practice Address - Fax:812-450-6710
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46091207Q00000X
IN01072730A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine