Healthcare Provider Details

I. General information

NPI: 1528532868
Provider Name (Legal Business Name): HEKYONG KANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E 24TH ST
NEW YORK NY
10010-4020
US

IV. Provider business mailing address

360 1ST AVE APT 12D
NEW YORK NY
10010-4915
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9516
  • Fax:
Mailing address:
  • Phone: 317-384-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901021461
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number062921-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: