Individual
JEAN KANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1808 VERDUGO BLVD STE 312, GLENDALE, CA 91208-1456
(818) 790-6721
Mailing address
4323 BRUNSWICK AVE, LOS ANGELES, CA 90039-1201
(909) 618-5240
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS103652
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103652
DENTAL LICENSE
—
Enumeration date
04/07/2017
Last updated
03/07/2023
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