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General NPI Number Information
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NPI Number | 1154022317
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Entity Type | Organization
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Legal Business Name | STEPHANIE KANG, DMD, PLLC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 21005 44TH AVE W STE 103
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3584
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Country | US
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Telephone | 425-616-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 21005 44TH AVE W STE 103
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3584
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Country | US
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Telephone | 425-616-2331
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | STEPHANIE KANG
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Credential | DMD
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Telephone | 617-997-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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