MEDICARE: MANJOT K KANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD424251	PA
2	207Q00000X	Family Medicine Physician	35-083889	OH

General Provider Information

NPI Number	:	1427057207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJOT K KANG MD

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-599-7466
Fax Number	:	440-593-6498

Provider Business Practice Location Address
First Line	:	167 W MAIN RD STE F
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2057
Country	:	US
Telephone Number	:	440-599-7466
Fax Number	:	440-593-6498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/08/2020

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