Provider Demographics
NPI:1871561803
Name:KANG, BRANDON SANG JOON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SANG JOON
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1746
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1746
Mailing Address - Country:US
Mailing Address - Phone:877-383-4442
Mailing Address - Fax:
Practice Address - Street 1:3620 HOWELL FERRY RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3178
Practice Address - Country:US
Practice Address - Phone:678-312-2400
Practice Address - Fax:678-312-6999
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0547642085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA149575161Medicaid
GAP00760856OtherRR MEDICARE
GA511I940015Medicare PIN