Active NPI
Willis Soo Kang, D.D.S.
- Dentist
- Los Angeles, CA
National Provider Identifier
1528319332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 26438
- Practice address
- 431 South Western Avenue
Los Angeles, CA 90020 - Phone
- (213) 383-2022
- NPI assigned
- Sep 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | 26438 | CA | Primary |
Addresses
Primary practice location
431 South Western Avenue
Los Angeles, CA 90020
Mailing address
431 South Western Avenue
Los Angeles, CA 90020
Other names 1
- Soo Cha Kang
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 |
|---|---|---|---|
| 26438 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348099200000",
"number": "1528319332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "431 SOUTH WESTERN AVENUE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 SOUTH WESTERN AVENUE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90020",
"telephone_number": "213-383-2022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANG",
"first_name": "WILLIS",
"middle_name": "SOO",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-20",
"last_updated": "2012-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "26438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SOO",
"last_name": "KANG",
"middle_name": "CHA",
"credential": "D.D.S.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.