Provider Demographics
NPI:1265428916
Name:KANG, DENO D (MD)
Entity type:Individual
Prefix:MR
First Name:DENO
Middle Name:D
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18102 PIONEER BLVD
Mailing Address - Street 2:NUMBER 204
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3953
Mailing Address - Country:US
Mailing Address - Phone:562-402-9801
Mailing Address - Fax:562-402-9802
Practice Address - Street 1:18102 PIONEER BLVD
Practice Address - Street 2:NUMBER 204
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3953
Practice Address - Country:US
Practice Address - Phone:562-402-9801
Practice Address - Fax:562-402-9802
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60288207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602880Medicaid
H07180Medicare UPIN
CA00A602880Medicaid