Healthcare Provider Details

I. General information

NPI: 1750731410
Provider Name (Legal Business Name): MORAE KAYE KANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LAKE ST
ADDISON IL
60101-2513
US

IV. Provider business mailing address

2050 E ALGONQUIN RD STE 610
SCHAUMBURG IL
60173-4166
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-4066
  • Fax: 847-496-4850
Mailing address:
  • Phone: 888-988-4066
  • Fax: 847-496-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019030668
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: