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General NPI Number Information
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NPI Number | 1326535949
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Entity Type | Individual
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Provider Name | HAEJIN KANG DDS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 3932 WILSHIRE BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90010-3307
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Country | US
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Telephone | 213-381-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 727 S ARDMORE AVE APT 803
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City | LOS ANGELES
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State | CA
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Zip | 90005-4368
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Country | US
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Telephone | 702-427-5500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 104674
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License Number State | CA
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