Healthcare Provider Details

I. General information

NPI: 1518171594
Provider Name (Legal Business Name): DAVID S KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2702
US

IV. Provider business mailing address

700 MEYER LN UNIT 8
REDONDO BEACH CA
90278-5280
US

V. Phone/Fax

Practice location:
  • Phone: 714-687-0800
  • Fax: 714-687-0880
Mailing address:
  • Phone: 310-770-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number44710
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: