Healthcare Provider Details

I. General information

NPI: 1578498572
Provider Name (Legal Business Name): DONGWAN KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E VIRGINIA WAY
BARSTOW CA
92311-3910
US

IV. Provider business mailing address

570 E VIRGINIA WAY
BARSTOW CA
92311-3910
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1010
  • Fax:
Mailing address:
  • Phone: 760-255-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: