Healthcare Provider Details

I. General information

NPI: 1518160043
Provider Name (Legal Business Name): YUNG-MING KANG DDS CAGS DSCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TULLY ROAD SUITE 602
MODESTO CA
95356-8982
US

IV. Provider business mailing address

4101 TULLY ROAD SUITE 602
MODESTO CA
95356-8982
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-1698
  • Fax: 209-529-0058
Mailing address:
  • Phone: 209-529-1698
  • Fax: 209-529-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number50146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: