Healthcare Provider Details

I. General information

NPI: 1871561803
Provider Name (Legal Business Name): BRANDON SANG JOON KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HOWELL FERRY RD
DULUTH GA
30096-3178
US

IV. Provider business mailing address

PO BOX 1746
INDIANAPOLIS IN
46206-1746
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-2400
  • Fax: 678-312-6999
Mailing address:
  • Phone: 877-383-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number054764
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number054764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: