Provider Demographics
NPI:1093846370
Name:KANG, BOBBY K (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:K
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2117012085R0202X
KS04-367732085R0202X
HIMD185042085R0202X
NE251312085R0202X
CO460462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093846370Medicaid
NM30230021Medicaid
CO99708302Medicaid
TX1093846370Medicaid
OK200237110AMedicaid
MT1093846370Medicaid
WY125845100Medicaid
AZ608811Medicaid
NE10025709000Medicaid
UT1093846370Medicaid
KS200602080AMedicaid
NE84-059792913Medicaid
SD1093846370/7729350Medicaid
UT1679513196Medicaid
CT1093846370/008026190Medicaid
CA1093846370Medicaid
CO444823ZLJ3Medicare PIN
KS111257069Medicare PIN
COCO304766Medicare PIN
COC810373Medicare PIN
COC810374Medicare PIN
UT1679513196Medicaid
NEP00796320Medicare PIN
NENA2517040Medicare PIN
CA1093846370Medicaid
WY125845100Medicaid
NENA1215034Medicare PIN