Provider Demographics
NPI:1104504968
Name:KANG, MATTHEW (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BRANDYWYN LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1101
Mailing Address - Country:US
Mailing Address - Phone:224-392-3773
Mailing Address - Fax:
Practice Address - Street 1:12 SALT CREEK LN STE 325
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8621
Practice Address - Country:US
Practice Address - Phone:630-856-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist