Han Jong Kang, D.D.S
Individual provider Active NPI General Practice Dentistry · Ridgefield, NJ
NPI 1346235397 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1346235397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DI0211300 (NJ)
- Practice address
- 777 Broad Ave
Ridgefield, NJ 07657-1001 - Phone
- (201) 945-0123
- Fax
- (201) 313-5252
- NPI assigned
- Sep 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI0211300 | NJ | MD | General Practice Dentistry |
| 048768 | NY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DI0211300 | NJ | Yes |
| General Practice Dentistry | 1223G0001X | 048768 | NY |
Addresses
Primary practice location
777 Broad Ave
Ridgefield, NJ 07657-1001
Mailing address
777 Broad Ave
Ridgefield, NJ 07657-1001
Phone (201) 945-0123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02064120 | Medicaid | NY |
Other providers in Ridgefield, NJ
- Johan Peguero
- Kristin Joson
- Jung F Wu MD PA
- Jy Lee Chiropractic LLC
- Mona Kahil
- Justin Kang
- Raffi Kaprielian
- Kata Physical Therapy PC
- Samerh M Khalil
- Jane Kyunghee Kim-Jin
All providers in Ridgefield, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.