Provider Demographics
NPI:1922482785
Name:KANG, JUSTIN (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 CENTER AVE
Mailing Address - Street 2:APT 8D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4948
Mailing Address - Country:US
Mailing Address - Phone:617-894-3438
Mailing Address - Fax:
Practice Address - Street 1:321 BROAD AVE
Practice Address - Street 2:BUILDING F5
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2346
Practice Address - Country:US
Practice Address - Phone:201-313-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 02602500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist