Individual provider Active NPI

Thomas C. Kang, DDS

  • Periodontics
  • Federal Way, WA
National Provider Identifier
1073697892
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Practice address
2505 S 320TH St
Suite 330
Federal Way, WA 98003-5400
Phone
(206) 400-0800
Fax
(523) 874-9068
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X WA Primary

Addresses

Primary practice location

2505 S 320TH St
Suite 330
Federal Way, WA 98003-5400

Mailing address

2572 Union Ave NE
Renton, WA 98059-3501
Phone (425) 271-4120

Other identifiers 1

IdentifierTypeStateIssuer
DE00010542WOtherWAWA. STATE I.D.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
602622493WAMDPeriodontist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1073697892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2572 UNION AVE NE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980593501",
            "telephone_number": "425-271-4120",
            "fax_number": "253-874-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 S 320TH ST",
            "address_2": "SUITE 330",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035400",
            "telephone_number": "206-400-0800",
            "fax_number": "523-874-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "THOMAS",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA. STATE I.D.",
            "identifier": "DE00010542W",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.