Provider Demographics
NPI:1851595110
Name:KANG, KAVITA AJ (DO)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:AJ
Last Name:KANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE, LOCATION E, FLOOR 4
Mailing Address - Street 2:MLC 5018
Mailing Address - City:CINCINNATTI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-9900
Mailing Address - Fax:513-803-0823
Practice Address - Street 1:3333 BURNET AVE, LOCATION E, FLOOR 4
Practice Address - Street 2:MLC 5018
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-9900
Practice Address - Fax:513-803-0823
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010993208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9358461OtherMEDICARE GROUP
OH2630700OtherMEDICAID GROUP