Provider Demographics
NPI:1215136304
Name:KANG DENTAL CORPORATION
Entity type:Organization
Organization Name:KANG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-288-0080
Mailing Address - Street 1:3925 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1933
Mailing Address - Country:US
Mailing Address - Phone:626-288-0080
Mailing Address - Fax:626-288-0086
Practice Address - Street 1:3925 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1933
Practice Address - Country:US
Practice Address - Phone:626-288-0080
Practice Address - Fax:626-288-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59163122300000X
CA51945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty