Provider Demographics
NPI:1205049491
Name:KANG, HEEJUNG VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:HEEJUNG
Middle Name:VICTORIA
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:265-535-5972
Mailing Address - Fax:256-535-5954
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:265-535-5972
Practice Address - Fax:256-535-5954
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.25034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN