1619175684 NPI number — DR. MYUNGSA KANG MD, MHS

Table of content: DR. MYUNGSA KANG MD, MHS (NPI 1619175684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619175684 NPI number — DR. MYUNGSA KANG MD, MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANG
Provider First Name:
MYUNGSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANG
Provider Other First Name:
MIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MHS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619175684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 271647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-5136
Provider Business Mailing Address Fax Number:
984-974-4873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N2198 UNC HOSPITALS
Provider Second Line Business Practice Location Address:
CB #7010
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-7010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-966-5136
Provider Business Practice Location Address Fax Number:
984-974-4873
Provider Enumeration Date:
07/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  200700822 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)