Healthcare Provider Details

I. General information

NPI: 1982285409
Provider Name (Legal Business Name): AYESHA S KANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

1400 US HIGHWAY 61 STE H1521
FESTUS MO
63028-4100
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-5337
  • Fax: 636-933-8090
Mailing address:
  • Phone: 636-933-5337
  • Fax: 636-933-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024035473
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2024035473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: