Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 29786 | AZ |
NPI | 1023002946 |
---|---|
Provider Name | Mandip S Kang |
First Address | Tempe, AZ 85284-3494 |
Second Address | Peoria, AZ 85381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
756249 | (05) | AZ |
F54166 | (02) | AZ |