Provider Demographics
NPI:1487119004
Name:KANG, HEE (PA)
Entity type:Individual
Prefix:
First Name:HEE
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:HEE-HOON
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2552 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3212
Mailing Address - Country:US
Mailing Address - Phone:404-547-0558
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1476
Practice Address - Country:US
Practice Address - Phone:404-778-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AS0400X
GA9172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical