Provider Demographics
NPI:1902006208
Name:KANG, JOSHUA TAEBONG I (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TAEBONG
Last Name:KANG
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531
Mailing Address - Country:US
Mailing Address - Phone:706-778-8645
Mailing Address - Fax:661-254-8760
Practice Address - Street 1:105 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:CA
Practice Address - Zip Code:30531
Practice Address - Country:US
Practice Address - Phone:706-778-8645
Practice Address - Fax:661-254-8760
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice