Basic Information
| Provider Information | |||||||||
| NPI: | 1922410364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANG | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | WONSUN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 FRANTZ RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430166102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145336497 | ||||||||
| FaxNumber: | 6145446370 | ||||||||
| Practice Location | |||||||||
| Address1: | 3595 OLENTANGY RIVER RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145665456 | ||||||||
| FaxNumber: | 6145661073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2014 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 34.013276 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.