Healthcare Provider Details

I. General information

NPI: 1437256435
Provider Name (Legal Business Name): JEAN YOUNG KANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 E FREMONT AVE STE 203
SUNNYVALE CA
94087-2973
US

IV. Provider business mailing address

1611 KRESKY AVE STE D
CENTRALIA WA
98531-8982
US

V. Phone/Fax

Practice location:
  • Phone: 408-774-0271
  • Fax:
Mailing address:
  • Phone: 360-736-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61232825
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: