Healthcare Provider Details

I. General information

NPI: 1134242258
Provider Name (Legal Business Name): JEANWAN KANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/01/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GERMANTOWN RD STE 101
DANBURY CT
06810-4087
US

IV. Provider business mailing address

41 GERMANTOWN RD STE 101
DANBURY CT
06810-4087
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-5680
  • Fax:
Mailing address:
  • Phone: 203-794-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number231438
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberLT-3858
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number18326
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35120023
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD92768
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1.082045
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: