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General NPI Number Information
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NPI Number | 1558078154
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Entity Type | Individual
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Provider Name | GURBINDER SINGH KANG
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Gender | Male
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 2605 COFFEE RD STE 200
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City | MODESTO
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State | CA
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Zip | 95355-2064
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Country | US
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Telephone | 209-521-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 17001 TULIP TREE WAY
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City | LATHROP
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State | CA
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Zip | 95330-8865
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Country | US
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Telephone | 209-406-0388
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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 | 108335
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License Number State | CA
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