Healthcare Provider Details

I. General information

NPI: 1013376110
Provider Name (Legal Business Name): MICHAEL KANG, DMD, MMSC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
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

509 OLIVE WAY STE 1633
SEATTLE WA
98101-1770
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 TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE60567455
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL KANG
Title or Position: OWNER
Credential: DMD, MMSC
Phone: 206-624-8313