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General NPI Number Information
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NPI Number | 1508081514
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Entity Type | Individual
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Provider Name | KYU CHAN KANG DDS
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 1400 N EDISON BLVD
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City | BURBANK
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State | CA
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Zip | 91505-1880
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Country | US
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Telephone | 818-736-6358
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Fax | 818-237-5304
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Provider Business Mailing Address
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Address Line | 10061 RIVERSIDE DR STE 444
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2560
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Country | US
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Telephone | 818-736-6358
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Fax | 818-237-5304
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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 | 29320
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License Number State | CA
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