Healthcare Provider Details

I. General information

NPI: 1235140427
Provider Name (Legal Business Name): BENHUR KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 HIGHWAY 78 SUITE#400
SACHSE TX
75048-4243
US

IV. Provider business mailing address

5120 HIGHWAY 78 SUITE#400
SACHSE TX
75048-4243
US

V. Phone/Fax

Practice location:
  • Phone: 972-414-2300
  • Fax:
Mailing address:
  • Phone: 972-414-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: