Provider Demographics
NPI:1871581157
Name:KANG, SU TONG (DDS)
Entity type:Individual
Prefix:
First Name:SU
Middle Name:TONG
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405A NEW LAGRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4049
Mailing Address - Country:US
Mailing Address - Phone:502-425-6021
Mailing Address - Fax:502-412-0077
Practice Address - Street 1:7405A NEW LAGRANGE ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4049
Practice Address - Country:US
Practice Address - Phone:502-425-6021
Practice Address - Fax:502-412-0077
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist