MEDICARE: DR. YOUNGMO KANG DDS

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	1223G0001X	General Practice Dentistry	23999	NJ

General Provider Information

NPI Number	:	1760611974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNGMO KANG DDS

Provider Business Mailing Address
First Line	:	88 GREENWICH ST
Second Line	:	APT 1604
City	:	NEW YORK
State	:	NY
Zip	:	10006
Country	:	US
Telephone Number	:	201-953-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 GREENWICH ST
Second Line	:	APT 1604
City	:	NEW YORK
State	:	NY
Zip	:	10006-2204
Country	:	US
Telephone Number	:	201-953-4316
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/09/2009

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