Healthcare Provider Details

I. General information

NPI: 1093946378
Provider Name (Legal Business Name): EUGENE C KANG MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 MITCHELL WAY SUITE 100
ERIE CO
80516-5445
US

IV. Provider business mailing address

671 MITCHELL WAY SUITE 100
ERIE CO
80516-5445
US

V. Phone/Fax

Practice location:
  • Phone: 303-954-0049
  • Fax: 720-638-7577
Mailing address:
  • Phone: 303-954-0049
  • Fax: 720-638-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR.0055871
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: