Provider Demographics
NPI:1356374631
Name:KANG, KATHERINE E (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:464 HUDSON TERRACE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-567-7725
Mailing Address - Fax:201-567-5255
Practice Address - Street 1:464 HUDSON TERRACE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-567-7725
Practice Address - Fax:201-567-5255
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07438800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9109102Medicaid
NJ068891Medicare ID - Type Unspecified
NJ9109102Medicaid