Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 231438 | MA |
N | 208600000X | Surgeon | 231438 | MA |
N | 2086S0129X | Vascular Surgeon | 18326 | NH |
N | 2086S0129X | Vascular Surgeon | 35120023 | OH |
Y | 2086S0129X | Vascular Surgeon | D92768 | MD |
N | 2086S0129X | Vascular Surgeon | LT-3858 | NH |
NPI | 1134242258 |
---|---|
Provider Name | Jeanwan Kang |
First Address | Baltimore, MD 21201-1504 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 26/10/2021 |