Provider Demographics
NPI:1811946866
Name:KANG, YOUNG WON (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:WON
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 1:4855 RIVER GREEN PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8333
Mailing Address - Country:US
Mailing Address - Phone:678-417-0077
Mailing Address - Fax:678-417-0337
Practice Address - Street 1:4855 RIVER GREEN PKWY STE 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8333
Practice Address - Country:US
Practice Address - Phone:678-417-0077
Practice Address - Fax:678-417-0337
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-066513207R00000X
GA056302207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG02726Medicare UPIN
GA11SCFXLMedicare ID - Type Unspecified
GA845218051AMedicare ID - Type Unspecified