Provider Demographics
NPI:1770779571
Name:KAN, IRENE MUNYUK (DMD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:MUNYUK
Last Name:KAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0251
Mailing Address - Country:US
Mailing Address - Phone:530-223-5500
Mailing Address - Fax:
Practice Address - Street 1:1667 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0251
Practice Address - Country:US
Practice Address - Phone:530-223-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist