Healthcare Provider Details

I. General information

NPI: 1780626630
Provider Name (Legal Business Name): KALLE KANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 560
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

1135 116TH AVE NE STE 560
BELLEVUE WA
98004-4631
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax: 425-462-8021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00024250
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-24537
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: