Provider Demographics
NPI:1942450929
Name:WOON JUNG KANG, DDS, LTD
Entity Type:Organization
Organization Name:WOON JUNG KANG, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WOON
Authorized Official - Middle Name:JUNG
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-769-0550
Mailing Address - Street 1:7725 BROADWAY
Mailing Address - Street 2:SUITE H
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4731
Mailing Address - Country:US
Mailing Address - Phone:219-769-0550
Mailing Address - Fax:219-769-0551
Practice Address - Street 1:7725 BROADWAY
Practice Address - Street 2:SUITE H
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4731
Practice Address - Country:US
Practice Address - Phone:219-769-0550
Practice Address - Fax:219-769-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1201091381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty