Provider Demographics
NPI:1992854673
Name:KANG, PHILIP Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:Y
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 PALISADE AVE
Mailing Address - Street 2:#2A
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6923
Mailing Address - Country:US
Mailing Address - Phone:201-947-8399
Mailing Address - Fax:
Practice Address - Street 1:1567 PALISADE AVE
Practice Address - Street 2:#2A
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6923
Practice Address - Country:US
Practice Address - Phone:201-947-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DJ022785001223P0300X
NY0522451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics