Healthcare Provider Details

I. General information

NPI: 1457642043
Provider Name (Legal Business Name): SUNG WOO KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18015 OAK ST STE A
OMAHA NE
68130-6097
US

IV. Provider business mailing address

18015 OAK ST STE A
OMAHA NE
68130-6097
US

V. Phone/Fax

Practice location:
  • Phone: 402-403-6988
  • Fax:
Mailing address:
  • Phone: 402-763-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1856704
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number063074
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7490
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number61975
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: