MEDICARE: KEVIN S KANG DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	108400	CA

General Provider Information

NPI Number	:	1578253258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S KANG DDS, MS

Provider Business Mailing Address
First Line	:	1375 MIDVALE AVE APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6260
Country	:	US
Telephone Number	:	909-969-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 MIDVALE AVE APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6260
Country	:	US
Telephone Number	:	909-969-3012
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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