Taeheon Kang, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

0401413327 Issued in VA

Practice address

3437 Lakeside Dr
Davie, FL 33328-1935

Phone

(954) 536-1111

NPI assigned

Jun 19, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deep Roots Periodontics PLLC

  • Periodontics
  • Fairfax, VA
  • NPI 1255695243
  NPD (past) Authorized official

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593820800000",
    "number": "1356578025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3437 LAKESIDE DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333281935",
            "telephone_number": "954-536-1111",
            "fax_number": "703-865-5913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3437 LAKESIDE DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333281935",
            "telephone_number": "954-536-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11130 Fairfax Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220305035",
            "country_code": "US",
            "telephone_number": "703-865-5911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANG",
        "first_name": "TAEHEON",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2020-07-04",
        "certification_date": "2020-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN18250",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "VA",
            "license": "0401413327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Levi Kahane, MD, PA
• Sandra Kahn, A.P.
• Sanchi Kalra, OD
• Jordan Michael Kaltman, DMD
• Steven I Kaltman, DMD
• Christopher Michael Kaouk, D.M.D.
• Nonna K Kaplan
• Olivia Grace Kaplan
• Kara Williams Counseling, LLC
• Karen Cordeiro, Inc.

• Periodontics in Davie, FL
• Providers in Davie, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2020; 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.