MEDICARE: DAH-IN AUDREY KANG DDS

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	1223G0001X	General Practice Dentistry	DDS109436	CA

General Provider Information

NPI Number	:	1528847589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAH-IN AUDREY KANG DDS

Provider Business Mailing Address
First Line	:	378 PERKINS ST
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 PERKINS ST
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6827
Country	:	US
Telephone Number	:	707-343-9990
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	01/07/2026

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