MEDICARE: DAE-WOOK KANG, M.D. PROFESSIONAL CORPORATION

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	261Q00000X	Clinic/Center	G79486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477736650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAE-WOOK KANG, M.D. PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2000 W HEDDING ST
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1426
Country	:	US
Telephone Number	:	408-280-5500
Fax Number	:	408-275-8311

Provider Business Practice Location Address
First Line	:	2000 W. HEDDING ST.
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1426
Country	:	US
Telephone Number	:	408-280-5500
Fax Number	:	408-275-8311

Authorized Official
Title or Position	:	CEO
Name	:	DR. DAE-WOOK KANG
Credential	:	M.D.
Telephone Number	:	408-280-5500

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	03/11/2009

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