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General NPI Number Information
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NPI Number | 1467973636
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Entity Type | Individual
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Provider Name | MICHAEL MO KANG DMD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 176 AUBURN ST
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City | AUBURN
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State | MA
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Zip | 01501-1635
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Country | US
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Telephone | 508-832-5731
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Fax |
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Provider Business Mailing Address
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Address Line | 460 FRANKLIN ST UNIT 316
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City | FRAMINGHAM
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State | MA
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Zip | 01702-6299
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Country | US
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Telephone | 631-371-9279
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN1858107
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License Number State | MA
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