MEDICARE: DR. PILGOO 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	1223P0700X	Prosthodontics	DI 20576	NJ

General Provider Information

NPI Number	:	1942427612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PILGOO KANG D.D.S

Provider Business Mailing Address
First Line	:	185 BRIDGE PLZ N
Second Line	:	SUITE 2
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5907
Country	:	US
Telephone Number	:	201-363-1033
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 BRIDGE PLZ N
Second Line	:	SUITE 2
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5907
Country	:	US
Telephone Number	:	201-363-1033
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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