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General NPI Number Information
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NPI Number | 1407379639
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Entity Type | Individual
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Provider Name | TAE HYUNG KANG DMD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 8400 NE VANCOUVER MALL LOOP
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City | VANCOUVER
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State | WA
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Zip | 98662-6671
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Country | US
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Telephone | 360-450-6639
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Fax |
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Provider Business Mailing Address
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Address Line | 14954 NW OLIVE ST
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City | PORTLAND
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State | OR
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Zip | 97229-7020
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Country | US
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Telephone | 503-901-3558
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 60760032
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License Number State | WA
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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 | D10675
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License Number State | OR
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