MEDICARE: DR. DONGYOUNG KANG DMD

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	1223G0001X	General Practice Dentistry	106558	CA

General Provider Information

NPI Number	:	1659012326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONGYOUNG KANG DMD

Provider Business Mailing Address
First Line	:	550 N ATLANTIC BLVD UNIT 353
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-7738
Country	:	US
Telephone Number	:	303-520-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E CARSON ST STE 300
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3075
Country	:	US
Telephone Number	:	562-988-7788
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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