Basic Information
| Provider Information | |||||||||
| NPI: | 1770842460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANG SMITH | ||||||||
| FirstName: | JUNG WOOK | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | KANG | ||||||||
| OtherFirstName: | JUNG WOOK | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1510 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477061510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708448027 | ||||||||
| FaxNumber: | 2708448183 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MARY ST STE 340 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477101679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124506700 | ||||||||
| FaxNumber: | 8124506710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2012 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 46091 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01072730A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.