MEDICARE: DR. POLLY KIANG D.D.S.

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	15337	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B15337-01	OTHER	TX	TEXAS CHIP PROVIDER #

General Provider Information

NPI Number	:	1740338342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POLLY KIANG D.D.S.

Provider Business Mailing Address
First Line	:	2907 PLANTERS ST
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-1821
Country	:	US
Telephone Number	:	713-779-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 CORPORATE DR
Second Line	:	SUITE 410
City	:	HOUSTON
State	:	TX
Zip	:	77036-3419
Country	:	US
Telephone Number	:	713-779-1127
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/09/2007

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Directions to “ DR. POLLY KIANG D.D.S.” Practice Location

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