Healthcare Provider Details

I. General information

NPI: 1881077907
Provider Name (Legal Business Name): DAVID JUNGJOO KANG DMD, MS, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 1633
SEATTLE WA
98101-1770
US

IV. Provider business mailing address

2720 3RD AVE APT 613
SEATTLE WA
98121-1297
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-8313
  • Fax:
Mailing address:
  • Phone: 206-319-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1856938
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60833718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: