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NPI Code Detail

MEDICARE: JI WON KANG DMD

MEDICARE: JI WON 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
1122300000XDentistDE61435599WA

General Provider Information

NPI Number : 1891579090
Entity Type Code : Individual
Provider Name (Legal Business Name) : JI WON KANG DMD
Provider Business Mailing Address
First Line : 13593 SW LIDEN DR
Second Line :
City : TIGARD
State : OR
Zip : 97223-2091
Country : US
Telephone Number : 971-517-9280
Fax Number :
Provider Business Practice Location Address
First Line : 4722 FAUNTLEROY WAY SW STE A
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4667
Country : US
Telephone Number : 206-928-6242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 08/21/2023

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Directions to “ JI WON KANG DMD” Practice Location

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