Provider Demographics
NPI:1457181695
Name:KANG, HANVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HANVIN
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 1:142 W BASE LINE RD STE B
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3302
Mailing Address - Country:US
Mailing Address - Phone:909-341-5325
Mailing Address - Fax:
Practice Address - Street 1:142 W BASE LINE RD STE B
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3302
Practice Address - Country:US
Practice Address - Phone:909-341-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist