Active NPI
Jason C Kang
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1114147360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 52068
- Practice address
- 3055 Wilshire Blvd
#110
Los Angeles, CA 90010-1118 - Phone
- (213) 385-5097
- Fax
- (213) 480-0374
- NPI assigned
- Apr 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 52068 | CA | Primary |
Addresses
Primary practice location
3055 Wilshire Blvd
#110
Los Angeles, CA 90010-1118
Mailing address
3055 Wilshire Blvd
#110
Los Angeles, CA 90010-1118
Phone (213) 385-5097
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
| License | State | Type | Specialty |
|---|---|---|---|
| 52068 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446508800000",
"number": "1114147360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3055 WILSHIRE BLVD",
"address_2": "#110",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900101118",
"telephone_number": "213-385-5097",
"fax_number": "213-480-0374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3055 WILSHIRE BLVD",
"address_2": "#110",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900101118",
"telephone_number": "213-385-5097",
"fax_number": "213-480-0374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANG",
"first_name": "JASON",
"middle_name": "C",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-30",
"last_updated": "2015-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "52068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.