Healthcare Provider Details

I. General information

NPI: 1811946866
Provider Name (Legal Business Name): YOUNG WON KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 RIVER GREEN PKWY STE 140
DULUTH GA
30096-8333
US

IV. Provider business mailing address

4855 RIVER GREEN PKWY STE 140
DULUTH GA
30096-8333
US

V. Phone/Fax

Practice location:
  • Phone: 678-417-0077
  • Fax: 678-417-0337
Mailing address:
  • Phone: 678-417-0077
  • Fax: 678-417-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-066513
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number056302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: