MEDICARE: DR. JAMES C KANG 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	P47148	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22D102443200	NJ

General Provider Information

NPI Number	:	1790926244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C KANG D.D.S.

Provider Business Mailing Address
First Line	:	155 ASHLAND PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 SHOPPES BLVD
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-2776
Country	:	US
Telephone Number	:	201-691-7570
Fax Number	:

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	04/08/2024

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