Provider Demographics
NPI:1154574812
Name:KANG, JENNIFER J (DMD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:KANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 LAS TABLAS RD STE C
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9731
Mailing Address - Country:US
Mailing Address - Phone:857-891-3466
Mailing Address - Fax:058-466-6340
Practice Address - Street 1:1105 LAS TABLAS RD STE C
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9731
Practice Address - Country:US
Practice Address - Phone:857-891-3466
Practice Address - Fax:058-466-6340
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0024274122300000X
CA62084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist