Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1856019 | MA |
Y | 1223D0001X | Dental Public Health | DE60550491 | WA |
N | 1223G0001X | General Practice | DE60550491 | WA |
N | 213EG0000X | General Practice | DE60550491 | WA |
NPI | 1548504277 |
---|---|
Provider Name | Stephanie Kang |
First Address | Seattle, WA 98104-3032 |
Second Address | Seattle, WA 98112-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 01/05/2019 |