Doctor Name: | DR. TAE HO KANG |
NPI Number: | 1255711693 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.M.D. |
License Number: | |
Business Practice Address: | 115 W Seminary Dr Suite 101 Fort Worth, TX - 761152635 |
Business Phone Number: | 8174052001 |
Business Fax Number: | |
Mailing Address: | 432 Samuels Ave, Apt. 5103 FORT WORTH |
State: | TX |
Postal Code: | 761022479 |
Phone Number: | 5517950990 |
Fax Number: | |
NPI Enumeration Date: | 06/01/2015 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |