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General NPI Number Information
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NPI Number | 1215136304
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Entity Type | Organization
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Legal Business Name | KANG DENTAL CORPORATION
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 01/16/2010
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Provider Practice Location Address
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Address Line | 3925 ROSEMEAD BLVD SUITE 203
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City | ROSEMEAD
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State | CA
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Zip | 91770-1933
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Country | US
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Telephone | 626-288-0080
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Fax | 626-288-0086
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Provider Business Mailing Address
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Address Line | 3925 ROSEMEAD BLVD SUITE 203
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City | ROSEMEAD
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State | CA
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Zip | 91770-1933
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Country | US
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Telephone | 626-288-0080
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Fax | 626-288-0086
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Authorized Official
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Title or Position | SECRETATRY
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Name | DR. JENNIFER C LEE
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Credential | DDS
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Telephone | 626-288-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 51945
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59163
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License Number State | CA
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