Provider Demographics
NPI:1194741272
Name:KANG, DAE-WOOK (MD)
Entity type:Individual
Prefix:
First Name:DAE-WOOK
Middle Name:
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 1:2000 W. HEDDING ST.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1426
Mailing Address - Country:US
Mailing Address - Phone:408-280-5500
Mailing Address - Fax:408-275-8311
Practice Address - Street 1:2000 W HEDDING ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1426
Practice Address - Country:US
Practice Address - Phone:408-280-5500
Practice Address - Fax:408-275-8311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G794860Medicaid
CA00G794860Medicare ID - Type Unspecified
CA00G794860Medicaid