Provider Demographics
NPI:1891492021
Name:SJ KANG DENTAL ONE, PLLC
Entity Type:Organization
Organization Name:SJ KANG DENTAL ONE, PLLC
Other - Org Name:ESTRELLA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOJOONG
Authorized Official - Middle Name:
Authorized Official - Last Name:RYU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-827-7554
Mailing Address - Street 1:1017 FORT WORTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5404
Mailing Address - Country:US
Mailing Address - Phone:469-827-7554
Mailing Address - Fax:
Practice Address - Street 1:1017 FORT WORTH ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5404
Practice Address - Country:US
Practice Address - Phone:469-827-7554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty