Healthcare Provider Details

I. General information

NPI: 1548556749
Provider Name (Legal Business Name): LEAH ELIZABETH KANG-OH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH ELIZABETH KANG D.O.

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 HIGHLAND OAKS DR SUITE 201
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-0020
  • Fax: 336-765-0581
Mailing address:
  • Phone: 336-765-0020
  • Fax: 336-765-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number284166
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2018-01201
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: