Healthcare Provider Details

I. General information

NPI: 1720762131
Provider Name (Legal Business Name): AIN KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE ROAD BUILDING 5513
EDWARDS AFB CA
39524
US

IV. Provider business mailing address

30 NIGHTINGALE ROAD BUILDING 5513
EDWARDS AFB CA
39524
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-7118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025021245
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: