Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 050394 | NY |
N | 122300000X | Dentist | DN012894 | GA |
Y | 1223P0700X | Prosthodontist | 050394-1 | NY |
NPI | 1215912134 |
---|---|
Provider Name | Dr. Young Suk Kang |
First Address | Fort Bragg, NC 28310-0001 |
Second Address | Fort Bragg, NC 28310-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 18/06/2014 |