Jiwon Kang, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

27908 Issued in TX

Practice address

410 Canyon St
Plainview, TX 79072-7508

Phone

(806) 291-0297

NPI assigned

Dec 10, 2008

Last updated

Dec 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Regence Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Plainview, TX
  • NPI 1083613640
  Medicare reassignment NPD
• Regence Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Amarillo, TX
  • NPI 1003813056
  NPD
• Regence Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Plainview, TX
  • NPI 1396741237
  NPD

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1841435591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RHN MEDICAL AND DENTAL GROUP",
            "address_2": "3113 ROSS ST",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "79118",
            "telephone_number": "806-374-7341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CANYON ST",
            "city": "PLAINVIEW",
            "state": "TX",
            "postal_code": "790727508",
            "telephone_number": "806-291-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "JIWON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-10",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "27908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Johnson, LCDC
• Jon Watkins M.D. P.a.
• Kevin C Jones, DO
• Samuel L Jurado Jr., P.A.
• Bhupala Raju Kallepalli, MD
• Amy Lynn Kellison, LPC
• Larry Melvin Keltz, LPC, LCDC, LSOTP
• Kevin L Stewart, MD, PA (LegMan Vein)
• Rhealine Edwinna Kilburn, COTA
• Christine Kim, DDS

• General Practice Dentistry in Plainview, TX
• Providers in Plainview, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.

Verify at the official NPI Registry.