Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0401411732 | VA |
NPI | 1164642799 |
---|---|
Provider Name | Dr. Minku Kang |
First Address | Fairfax, VA 22031-3757 |
Second Address | Fairfax, VA 22031-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |