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General NPI Number Information
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NPI Number | 1477736650
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Entity Type | Organization
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Legal Business Name | DAE-WOOK KANG, M.D. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 2000 W. HEDDING ST. SUITE 10
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City | SAN JOSE
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State | CA
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Zip | 95128-1426
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Country | US
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Telephone | 408-280-5500
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Fax | 408-275-8311
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Provider Business Mailing Address
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Address Line | 2000 W HEDDING ST SUITE 10
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City | SAN JOSE
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State | CA
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Zip | 95128-1426
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Country | US
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Telephone | 408-280-5500
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Fax | 408-275-8311
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Authorized Official
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Title or Position | CEO
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Name | DR. DAE-WOOK KANG
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Credential | M.D.
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Telephone | 408-280-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G79486
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License Number State | CA
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