Joshua Taebong Kang I, DMD
Individual provider Active NPI General Practice Dentistry · Cornelia, CA
NPI 1902006208 · NPPES record last updated Nov 16, 2017
Key facts
- NPI
- 1902006208
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 36775 (CA)
- Practice address
- 105 Highland Avenue
Cornelia, CA 30531 - Phone
- (706) 778-8645
- Fax
- (661) 254-8760
- NPI assigned
- Jul 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36775 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ralph L. Jackson, DDS, PC | Past | Accepting new patients | |
| Seattle Indian Health Board | Past | Accepting new patients | |
| Cornelia Dental, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 36775 | CA | Yes |
Addresses
Primary practice location
105 Highland Avenue
Cornelia, CA 30531
Mailing address
105 Highland Avenue
Cornelia, GA 30531
Phone (706) 778-8645
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.