=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295012136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONIA SHEMINDERJIT KANG D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2011
-----------------------------------------------------
Last Update Date | 04/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7436 WOODWARD AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48202-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-556-9907
-----------------------------------------------------
Fax | 313-556-9711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6535 ROCHESTER RD STE 106
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-879-4548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2901019037
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------