Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301086626 | MI |
N | 208600000X | Surgeon | 4301086626 | MI |
N | 2086S0129X | Vascular Surgeon | 54147 | MN |
Y | 2086S0129X | Vascular Surgeon | 70309 | GA |
NPI | 1154504082 |
---|---|
Provider Name | Edward Park Kang |
First Address | Atlanta, GA 30342-1626 |
Second Address | Canton, GA 30115-8017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003135923A | (05) | GA |
003135923B | (05) | GA |
003135923D | (05) | GA |