MEDICARE: KANG & CHANG DENTAL GROUP INC

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	122300000X	Dentist	51048	CA
2	122300000X	Dentist	40624	CA

General Provider Information

NPI Number	:	1881139442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANG & CHANG DENTAL GROUP INC

Provider Business Mailing Address
First Line	:	2520 W 8TH ST
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 W 8TH ST
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-380-1894
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEONG KANG
Credential	:
Telephone Number	:	213-380-1894

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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