Provider Demographics
NPI:1134242258
Name:KANG, JEANWAN (MD)
Entity type:Individual
Prefix:
First Name:JEANWAN
Middle Name:
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 1:41 GERMANTOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4087
Mailing Address - Country:US
Mailing Address - Phone:203-794-5680
Mailing Address - Fax:
Practice Address - Street 1:41 GERMANTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4087
Practice Address - Country:US
Practice Address - Phone:203-794-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231438208600000X
NHLT-38582086S0129X
NH183262086S0129X
OH351200232086S0129X
MDD927682086S0129X
CT1.0820452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery