Provider Demographics
NPI:1801386198
Name:KANG, HYUN KYU
Entity Type:Individual
Prefix:DR
First Name:HYUN KYU
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BORAMAEKYUNGNAMHONORSVILLE APT 106-203
Mailing Address - Street 2:YOUNGDEUNGPOGU YEOUIDAEBANGRO 25
Mailing Address - City:SEOUL
Mailing Address - State:NA
Mailing Address - Zip Code:07437
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1192 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4752
Practice Address - Country:US
Practice Address - Phone:860-585-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT115411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice