NPIMap

Individual provider Active NPI

Joshua Taebong Kang I, DMD

  • General Practice Dentistry
  • Cornelia, CA
National Provider Identifier
1902006208
Registry record updated Nov 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
36775 Issued in CA
Practice address
105 Highland Avenue
Cornelia, CA 30531
Phone
(706) 778-8645
Fax
(661) 254-8760
NPI assigned
Jul 24, 2007
Last updated
Nov 16, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 36775 CA Primary

Addresses

Primary practice location

105 Highland Avenue
Cornelia, CA 30531

Mailing address

105 Highland Avenue
Cornelia, GA 30531
Phone (706) 778-8645

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cornelia Dental, LLC Past Accepting new patients
Seattle Indian Health Board Past Accepting new patients
Ralph L. Jackson, DDS, PC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510790400000",
    "number": "1902006208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND AVENUE",
            "city": "CORNELIA",
            "state": "GA",
            "postal_code": "30531",
            "telephone_number": "706-778-8645",
            "fax_number": "661-254-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND AVENUE",
            "city": "CORNELIA",
            "state": "CA",
            "postal_code": "30531",
            "telephone_number": "706-778-8645",
            "fax_number": "661-254-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "JOSHUA",
        "middle_name": "TAEBONG",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2017-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; 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.