Provider Demographics
NPI:1356723076
Name:KANG, DONGGIL (DDS)
Entity type:Individual
Prefix:DR
First Name:DONGGIL
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 1:1414 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1414
Mailing Address - Country:US
Mailing Address - Phone:626-714-7871
Mailing Address - Fax:626-714-7876
Practice Address - Street 1:668 N LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1004
Practice Address - Country:US
Practice Address - Phone:626-714-7871
Practice Address - Fax:626-714-7876
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice