MEDICARE: C GREGORY KANG MD PA

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	208100000X	Physical Medicine & Rehabilitation Physician	19925	SC

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	:	1619174687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C GREGORY KANG MD PA

Provider Business Mailing Address
First Line	:	PO BOX 811
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-0811
Country	:	US
Telephone Number	:	843-215-8868
Fax Number	:	843-215-9555

Provider Business Practice Location Address
First Line	:	3029 NEWCASTLE LOOP
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588
Country	:	US
Telephone Number	:	843-215-8868
Fax Number	:	843-215-9555

Authorized Official
Title or Position	:	OWNER
Name	:	C GREGORY KANG
Credential	:	M.D.
Telephone Number	:	843-215-8868

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	01/03/2012

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