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General NPI Number Information
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NPI Number | 1336257443
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Entity Type | Individual
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Provider Name | TAI KYUN KANG MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 401 S BALLENGER HWY
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City | FLINT
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State | MI
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Zip | 48532-3638
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Country | US
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Telephone | 810-610-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 9395 BURNING TREE DRIVE PO BOX 460
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City | GRAND BLANC
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State | MI
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Zip | 48480-0460
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Country | US
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Telephone | 810-423-2834
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | TK031690
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License Number State | MI
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