MEDICARE: TAEMIN KANG

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	225100000X	Physical Therapist	PTL89105	MA

General Provider Information

NPI Number	:	1588516975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAEMIN KANG

Provider Business Mailing Address
First Line	:	484 2ND ST APT 5021
Second Line	:
City	:	EVERETT
State	:	MA
Zip	:	02149-4446
Country	:	US
Telephone Number	:	518-321-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1493 CAMBRIDGE ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1047
Country	:	US
Telephone Number	:	617-665-1000
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ TAEMIN KANG ” Practice Location

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