MEDICARE: NANCY KANG M.D.

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	243876	MA
2	207RG0100X	Gastroenterology Physician	LP02764	RI
3	207RG0100X	Gastroenterology Physician	55249	CT

General Provider Information

NPI Number	:	1447570494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KANG M.D.

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE STE 3212
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-522-1171
Fax Number	:	860-493-6524

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 3212
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-522-1171
Fax Number	:	860-493-6524

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

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	05/24/2016

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