Provider Demographics
NPI:1700255015
Name:KANG, ALBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3518
Mailing Address - Country:US
Mailing Address - Phone:253-268-1184
Mailing Address - Fax:
Practice Address - Street 1:18010 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98148-1908
Practice Address - Country:US
Practice Address - Phone:206-812-2460
Practice Address - Fax:206-812-2455
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60581724122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice