Healthcare Provider Details

I. General information

NPI: 1508243254
Provider Name (Legal Business Name): TONY KANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LITTLETON RD STE 1
WESTFORD MA
01886
US

IV. Provider business mailing address

SEVEN SPRINGS LANE UNIT 16H
BURLINGTON MA
01803
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-9095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1858224
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: