Provider Demographics
NPI:1255015541
Name:KANG, JUSTIN (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
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 1:4030 FM 1463 RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5499
Mailing Address - Country:US
Mailing Address - Phone:734-546-0373
Mailing Address - Fax:
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4440
Practice Address - Country:US
Practice Address - Phone:281-994-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist