Provider Demographics
NPI:1356578025
Name:KANG, TAEHEON (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TAEHEON
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1935
Mailing Address - Country:US
Mailing Address - Phone:954-536-1111
Mailing Address - Fax:703-865-5913
Practice Address - Street 1:3437 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1935
Practice Address - Country:US
Practice Address - Phone:954-536-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182501223P0300X
VA04014133271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics