Individual
SUSAN KANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12752 71ST ST APT 101, KENOSHA, WI 53142-8428
(708) 217-8489
Mailing address
12752 71ST ST APT 101, KENOSHA, WI 53142-8428
(708) 217-8489
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019030713
IL
122300000X
Dentist
Primary
1001464
WI
Other
Enumeration date
05/06/2015
Last updated
07/21/2022
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