Basic Information
| Provider Information | |||||||||
| NPI: | 1427057207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANG | ||||||||
| FirstName: | MANJOT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8792 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405997466 | ||||||||
| FaxNumber: | 4405936498 | ||||||||
| Practice Location | |||||||||
| Address1: | 167 W MAIN RD STE F | ||||||||
| Address2: | |||||||||
| City: | CONNEAUT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440302057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405997466 | ||||||||
| FaxNumber: | 4405936498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD424251 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35-083889 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.