Michael Doo Hyun Kang, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

11743 Issued in CT

Practice address

469 Buckland Rd Ste 203
South Windsor, CT 06074-3737

Phone

(860) 644-2340

NPI assigned

May 14, 2015

Sex

Male

Sole proprietor

Yes

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

State licenses

Practice roles

Locations

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.

• South Windsor Perio, PLLC

  • Periodontics
  • South Windsor, CT
  • NPI 1336832641
  NPD Authorized official

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1417335142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 BUCKLAND RD STE 203",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743737",
            "telephone_number": "608-644-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 BUCKLAND RD STE 203",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743737",
            "telephone_number": "860-644-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "MICHAEL",
        "middle_name": "DOO HYUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-14",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "057084",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "11743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Journey Towards Healing U, LLC
• Shelley Judd, LPC
• Julie Jason LPC, LLC
• Carmen M Julien
• Vasanth Kainkaryam, MD
• Karen Foley-Schain Ma Med LLC
• Stacy Karpowitz, L.M.F.T.
• Kathleen M. Friend LMFT LLC
• Navneet Kaur, APRN, FNP-BC
• Kara Greenleat Keeton, M.D.

• Periodontics in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; 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.