Provider Demographics
NPI:1215912134
Name:KANG, YOUNG SUK (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:SUK
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA DENTAC
Mailing Address - Street 2:B 2817 REILLY ROAD
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2082
Practice Address - Street 1:USA DENTAC
Practice Address - Street 2:B 2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050394122300000X
GADN012894122300000X
NY050394-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist