Provider Demographics
NPI:1649479932
Name:KANG, PETER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LEE
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8919
Mailing Address - Fax:
Practice Address - Street 1:6481 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2377
Practice Address - Country:US
Practice Address - Phone:717-796-9355
Practice Address - Fax:717-620-8093
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089566207P00000X
PAMD433950207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102223008Medicaid
PA102223008Medicaid