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NPI Code Detail

MEDICARE: JACQUELYN KANG MD

MEDICARE: JACQUELYN KANG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician217113MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033104328
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN KANG MD
Provider Business Mailing Address
First Line : 421 N MAIN ST
Second Line :
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-584-4040
Fax Number :
Provider Business Practice Location Address
First Line : 421 N MAIN ST
Second Line :
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-584-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 05/28/2024

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