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General NPI Number Information
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NPI Number | 1942450929
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Entity Type | Organization
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Legal Business Name | WOON JUNG KANG, DDS, LTD
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 7725 BROADWAY SUITE H
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City | MERRILLVILLE
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State | IN
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Zip | 46410-4731
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Country | US
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Telephone | 219-769-0550
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Fax | 219-769-0551
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Provider Business Mailing Address
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Address Line | 7725 BROADWAY SUITE H
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City | MERRILLVILLE
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State | IN
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Zip | 46410-4731
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Country | US
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Telephone | 219-769-0550
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Fax | 219-769-0551
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Authorized Official
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Title or Position | OWNER
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Name | WOON JUNG KANG
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Credential | DDS
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Telephone | 219-769-0550
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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 | 120109138
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License Number State | IN
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