=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881780484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEAN H. KANG, DDS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 666 PLAINSBORO ROAD SUITE 608
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-799-7427
-----------------------------------------------------
Fax | 609-799-7428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 666 PLAINSBORO ROAD SUITE 608
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-799-7427
-----------------------------------------------------
Fax | 609-799-7428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ENDODONTIST
-----------------------------------------------------
Name | DR. JEAN H. KANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 609-799-7427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 22D102110000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------