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General NPI Number Information
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NPI Number | 1881077907
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Entity Type | Individual
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Provider Name | DAVID JUNGJOO KANG DMD, MS, MMSC
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 509 OLIVE WAY STE 1633
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City | SEATTLE
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State | WA
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Zip | 98101-1770
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Country | US
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Telephone | 206-624-8313
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 3RD AVE APT 613
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City | SEATTLE
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State | WA
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Zip | 98121-1297
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Country | US
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Telephone | 206-319-6792
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856938
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DE60833718
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License Number State | WA
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