Basic Information
| Provider Information | |||||||||
| NPI: | 1134189780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4815 LIBERTY AVE STE 425 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781849 | ||||||||
| FaxNumber: | 4125780259 | ||||||||
| Practice Location | |||||||||
| Address1: | 4815 LIBERTY AVE STE 425 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781849 | ||||||||
| FaxNumber: | 4125780259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD422092 | PA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0105X | MD422092 | PA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 3810010925 | 05 | WV | MEDICAID | 001971543 | 05 | PA | MEDICAID | 2850713 | 05 | OH | MEDICAID |