Provider Demographics
NPI:1447305586
Name:TING, KANG (DMD)
Entity type:Individual
Prefix:
First Name:KANG
Middle Name:
Last Name:TING
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 1:10833 LECONTE AVENUE CHS # 20-140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1669
Mailing Address - Country:US
Mailing Address - Phone:310-825-5161
Mailing Address - Fax:310-206-5349
Practice Address - Street 1:10833 LECONTE AVE CHS # 20-140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1669
Practice Address - Country:US
Practice Address - Phone:310-825-5161
Practice Address - Fax:310-206-5349
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD513981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01005-2Medicaid