Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DR.0055871 | CO |
NPI | 1093946378 |
---|---|
Provider Name | Eugene C Kang |
First Address | Erie, CO 80516-5445 |
Second Address | Erie, CO 80516-5445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 14/02/2017 |