Healthcare Provider Details

I. General information

NPI: 1659532364
Provider Name (Legal Business Name): DANIEL GENE KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVENUE
TACOMA WA
98431
US

IV. Provider business mailing address

9040 JACKSON AVENUE
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1790
  • Fax: 314-747-2598
Mailing address:
  • Phone: 253-968-1790
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2014003380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: