MEDICARE: DAE-WOOK 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
1	207R00000X	Internal Medicine Physician	G079486	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1194741272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAE-WOOK KANG MD

Provider Business Mailing Address
First Line	:	2000 W. HEDDING ST.
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1426
Country	:	US
Telephone Number	:	408-280-5500
Fax Number	:	408-275-8311

Provider Business Practice Location Address
First Line	:	2000 W HEDDING ST
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1426
Country	:	US
Telephone Number	:	408-280-5500
Fax Number	:	408-275-8311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/10/2010

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