Provider Demographics
NPI:1174920946
Name:KANG, JULIA HYUNJOO (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:HYUNJOO
Last Name:KANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:HYUN
Other - Middle Name:JOO
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5909 BASSINGHALL LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4724
Mailing Address - Country:US
Mailing Address - Phone:857-636-9678
Mailing Address - Fax:
Practice Address - Street 1:1101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:817-786-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305271223X0400X
MADN1856780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist