Healthcare Provider Details

I. General information

NPI: 1093136087
Provider Name (Legal Business Name): DENO D KANG M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 PIONEER BLVD SUITE 204
ARTESIA CA
90701-3953
US

IV. Provider business mailing address

18102 PIONEER BLVD SUITE 204
ARTESIA CA
90701-3953
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-9801
  • Fax: 562-402-9802
Mailing address:
  • Phone: 562-402-9801
  • Fax: 562-402-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA60288
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA60288
License Number StateCA

VIII. Authorized Official

Name: JIN KANG
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-319-8976