Active NPI
Hahngoo Justin Kahng, DDS
- Dentist
- Provo, UT
National Provider Identifier
1366173379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12904283-9922
- Practice address
- 3707 N Canyon Rd Ste 2a
Provo, UT 84604-4525 - Phone
- (801) 997-5875
- NPI assigned
- Jun 21, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12904283-9922 | UT | Primary |
Addresses
Primary practice location
3707 N Canyon Rd Ste 2a
Provo, UT 84604-4525
Mailing address
447 S Pegasus Way
Saratoga Springs, UT 84045-4520
Phone (425) 785-5458
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 |
|---|---|---|---|
| 12904283-9922 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656547200000",
"number": "1366173379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "447 S PEGASUS WAY",
"city": "SARATOGA SPRINGS",
"state": "UT",
"postal_code": "840454520",
"telephone_number": "425-785-5458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3707 N CANYON RD STE 2A",
"city": "PROVO",
"state": "UT",
"postal_code": "846044525",
"telephone_number": "801-997-5875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAHNG",
"first_name": "HAHNGOO",
"middle_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-21",
"last_updated": "2022-06-30",
"certification_date": "2022-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "12904283-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.