Provider Demographics
NPI:1265518880
Name:KHANG, EUGENE KYUNGMOOK (DMD)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:KYUNGMOOK
Last Name:KHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2401
Mailing Address - Country:US
Mailing Address - Phone:617-576-5300
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2401
Practice Address - Country:US
Practice Address - Phone:617-576-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice