MEDICARE: DR. PETER KEN KANG MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	D0012744	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1795473	OTHER	MD	CAQH
2	600852	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1629082391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER KEN KANG MD

Provider Business Mailing Address
First Line	:	3 NASHUA CT
Second Line	:	SUITE H
City	:	BALTIMORE
State	:	MD
Zip	:	21221-3133
Country	:	US
Telephone Number	:	410-933-5678
Fax Number	:	410-933-4835

Provider Business Practice Location Address
First Line	:	1952A PULASKI HWY
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-1617
Country	:	US
Telephone Number	:	410-538-7000
Fax Number	:	410-679-7825

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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