Active NPI
Heenam Kang, DDS
- Dentist
- Ontario, CA
National Provider Identifier
1760525968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29319
- Practice address
- 2234A South Euclid Ave
Ontario, CA 91762-6501 - Phone
- (909) 986-6866
- Fax
- (909) 986-1053
- NPI assigned
- Feb 15, 2007
- 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 | 29319 | CA | Primary |
Addresses
Primary practice location
2234A South Euclid Ave
Ontario, CA 91762-6501
Mailing address
2234A South Euclid Ave
Ontario, CA 91762-6501
Phone (909) 986-6866
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B2931901 | Other | CA | DENTI CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150629000311 | CA | Order and Referring Only - Dentist | 3173835519 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29319 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760525968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2234A SOUTH EUCLID AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917626501",
"telephone_number": "909-986-6866",
"fax_number": "909-986-1053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2234A SOUTH EUCLID AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917626501",
"telephone_number": "909-986-6866",
"fax_number": "909-986-1053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANG",
"first_name": "HEENAM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "29319",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI CAL",
"identifier": "B2931901",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.