Provider Demographics
NPI:1134956329
Name:KEVIN KANG DDS MS INC
Entity type:Organization
Organization Name:KEVIN KANG DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SANGWOO
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:909-969-3012
Mailing Address - Street 1:1001 TIVERTON AVE APT 3140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3097
Mailing Address - Country:US
Mailing Address - Phone:909-969-3012
Mailing Address - Fax:
Practice Address - Street 1:1808 VERDUGO BLVD STE 312
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1456
Practice Address - Country:US
Practice Address - Phone:909-969-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental