MEDICARE: DR. HYUN KYU KANG

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	11541	CT

General Provider Information

NPI Number	:	1801386198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN KYU KANG

Provider Business Mailing Address
First Line	:	BORAMAEKYUNGNAMHONORSVILLE APT 106-203
Second Line	:	YOUNGDEUNGPOGU YEOUIDAEBANGRO 25
City	:	SEOUL
State	:	NA
Zip	:	07437
Country	:	KR
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1192 FARMINGTON AVE
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-4752
Country	:	US
Telephone Number	:	860-585-9000
Fax Number	:

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

Provider Enumeration Date	:	05/13/2018
Last Update Date	:	05/13/2018

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