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General NPI Number Information
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NPI Number | 1760703144
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Entity Type | Individual
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Provider Name | JI YEON JEMMA KANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2010
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE. ML 2001
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 513-636-4408
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Fax | 513-636-7337
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVE. ML 2001
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-4408
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Fax | 513-636-7337
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01077149A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 35.131873
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License Number State | OH
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