Active NPI
Jongho Kang
- Dentist
- Stockton, CA
National Provider Identifier
1427883826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 110414
- Practice address
- 10928 Trinity Pkwy
Stockton, CA 95219-7230 - Phone
- (209) 474-8000
- NPI assigned
- Sep 5, 2024
- Last updated
- Sep 5, 2024
- 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 | 110414 | CA | Primary |
Addresses
Primary practice location
10928 Trinity Pkwy
Stockton, CA 95219-7230
Mailing address
2829 Breaker Way Apt 1432
Stockton, CA 95209-4432
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 |
|---|---|---|---|
| 110414 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1427883826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2829 BREAKER WAY APT 1432",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952094432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10928 TRINITY PKWY",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952197230",
"telephone_number": "209-474-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANG",
"first_name": "JONGHO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-05",
"last_updated": "2024-09-05",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "110414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.