MEDICARE: YOUNGMO KANG, DDS INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619734407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNGMO KANG, DDS INC

Provider Business Mailing Address
First Line	:	10521 VALLEY VIEW ST
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4832
Country	:	US
Telephone Number	:	714-723-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	10521 VALLEY VIEW ST
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4832
Country	:	US
Telephone Number	:	714-723-2035
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOUNGMO KANG
Credential	:	DDS
Telephone Number	:	714-723-2035

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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