Healthcare Provider Details

I. General information

NPI: 1326535949
Provider Name (Legal Business Name): HAEJIN KANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3932 WILSHIRE BLVD STE 200
LOS ANGELES CA
90010-3307
US

IV. Provider business mailing address

727 S ARDMORE AVE APT 803
LOS ANGELES CA
90005-4368
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-5437
  • Fax:
Mailing address:
  • Phone: 702-427-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104674
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: