Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401411482 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 057970 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 57970 | CA |
NPI | 1083799316 |
---|---|
Provider Name | Dr. Christopher Kang |
First Address | Palmdale, CA 93551 |
Second Address | Palmdale, CA 93551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 02/11/2016 |