Healthcare Provider Details

I. General information

NPI: 1992054787
Provider Name (Legal Business Name): MICHAEL KANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 1633
SEATTLE WA
98101
US

IV. Provider business mailing address

509 OLIVE WAY SUITE 1633
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-8313
  • Fax: 206-624-8922
Mailing address:
  • Phone: 206-624-8313
  • Fax: 206-624-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856135
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60567455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: