Provider Demographics
NPI:1427057207
Name:KANG, MANJOT K (MD)
Entity type:Individual
Prefix:
First Name:MANJOT
Middle Name:K
Last Name:KANG
Suffix:
Gender:F
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:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-599-7466
Mailing Address - Fax:440-593-6498
Practice Address - Street 1:167 W MAIN RD STE F
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2057
Practice Address - Country:US
Practice Address - Phone:440-599-7466
Practice Address - Fax:440-593-6498
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424251207Q00000X
OH35-083889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081281E7CMedicare PIN