Doctor Name: | DR. CHANGGEUM KANG |
NPI Number: | 1619198918 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 750 S State St Elgin, IL - 601237612 |
Business Phone Number: | 8477421040 |
Business Fax Number: | 8474294996 |
Mailing Address: | 900 Harvest Ln, MOUNT PROSPECT |
State: | IL |
Postal Code: | 600562698 |
Phone Number: | 8472597899 |
Fax Number: | |
NPI Enumeration Date: | 05/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |