Provider Demographics
NPI:1003645839
Name:KANG, MINJI HAILEY
Entity type:Individual
Prefix:
First Name:MINJI
Middle Name:HAILEY
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4832
Mailing Address - Country:US
Mailing Address - Phone:714-723-2035
Mailing Address - Fax:
Practice Address - Street 1:10521 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4832
Practice Address - Country:US
Practice Address - Phone:714-723-2035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36186124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist