DR. MINSOO KANG (NPI# 1780681569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780681569 |
| Entity Type | Individual |
| Full Name | DR. MINSOO KANG |
| Credential | MD |
| Practice Address |
400 S 43rd St Renton WA 98055 |
| Mailing Address |
3600 Lind Ave Sw Ste 100 Renton WA 98057-4970 |
| Practice Telephone | 4256565566 |
| Practice Fax Number | 4256565567 |
| Mailing Telephone | 4252283440 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2018-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
002006 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD60858392 | WA | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
002006 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02548516 | 05 | |
| WA | 2103758 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3980 Sheridan Dr, Suite 200, Amherst, NY 142261727 | 7162502000 | 7166361365 |
| Street Address |
400 S 43RD ST |
| City | RENTON |
| State | WA |
| Zip Code | 98055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700490760 | Toni Anne Wolcott | Registered Nurse | 400 S 43rd St, Renton, WA 98055 | 2020-09-06 |
| 1770107484 | Richmond Li | Registered Nurse | 400 S 43rd St, Renton, WA 98055-5714 | 2020-05-29 |
| 1144840711 | Brendan Wesley-smith | Registered Nurse | 400 S 43rd St, Renton, WA 98055-5714 | 2020-04-23 |
| 1205460359 | Yingying Lu | Registered Nurse | 400 S 43rd St, Renton, WA 98055-5714 | 2020-02-27 |
| 1508404955 | Hannah Rae Humphrey | Speech-Language Pathologist | 400 S 43rd St, Renton, WA 98055-5714 | 2019-12-17 |
| 1881232247 | Jennifer Susan Katz | Physical Therapist | 400 S 43rd St, Renton, WA 98055-5714 | 2019-12-17 |
| 1760029714 | Selam Estefanos | Registered Nurse | 400 S 43rd St, Renton, WA 98055-5714 | 2019-12-09 |
| 1407493133 | Alba Sari | Registered Nurse | 400 S 43rd St, Renton, WA 98055-5714 | 2019-12-02 |
| 1336784131 | Julia Lysyuk | Nurse Anesthetist, Certified Registered | 400 S 43rd St, Renton, WA 98055-5714 | 2019-11-15 |
| 1700429651 | Kelsey Anne Chicvara | Physical Therapist | 400 S 43rd St, Renton, WA 98055-5714 | 2019-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1851804959 | Talbot Rehabilitation Center, LLC | Skilled Nursing Facility | 4430 Talbot Road South, Renton, WA 98055 | 2017-11-10 |
| 1154878668 | Nelson Family Dentistry | Dentist | 19221 108th Ave Se Suite #2, Renton, WA 98055 | 2016-09-01 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1376960138 | Madhuri Gordhan Patel | Registered Nurse | 3501 Mill Place South, Renton, WA 98055 | 2014-03-18 |
| 1912331042 | Karen Dohr | Pharmacist | 400 S. 43 Street, Renton, WA 98055 | 2013-08-26 |
| 1659637668 | Benjamin Reiss | Ophthalmology | 4300 Talbot Rd S Ste 300, Renton, WA 98055 | 2012-04-03 |
| 1205137940 | Duy Ai Quang Hoang | Pharmacist | 9431 S 196th Pl, Renton, WA 98055 | 2010-11-11 |
| 1972823664 | Erica L Ellzey | Physical Therapist | 18623 112th Ave Se, Renton, WA 98055 | 2010-06-04 |
| 1588984587 | Melissa A. Jordan | Nurse Anesthetist, Certified Registered | 4011 Talbot Rd., 5th Floor, Renton, WA 98055 | 2010-06-02 |
| Find all providers in zip 98055 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154648608 | Jennifer Han | Psychiatry & Neurology | 4033 Talbot Rd S Ste 520, Renton, WA 98055-5774 | 2010-04-23 |
| 1619363983 | Derek William Wood | Psychiatry & Neurology | 400 S 43rd St, Renton, WA 98055-5714 | 2015-04-13 |
| 1215371935 | Makeda E Agonafer | Psychiatry & Neurology | 400 S 43rd St, Renton, WA 98055-5714 | 2013-04-24 |
| 1831485846 | Jennifer Lelia Davis | Psychiatry & Neurology | 400 S 43rd St, Renton, WA 98055-5714 | 2011-06-28 |
| 1609161181 | Sophia P Wang | Psychiatry & Neurology | 400 S 43rd St, Renton, WA 98055-5714 | 2011-06-13 |
| 1336464247 | Krista Kawaguchi | Psychiatry & Neurology | 400 S 43rd St, Renton, WA 98055-5714 | 2010-04-02 |
| 1770752248 | Baburaj Thankappan | Psychiatry & Neurology | 3915 Talbot Rd S, Suite 104, Renton, WA 98055-5738 | 2008-02-28 |
| 1982815676 | Sophia Huang Shao Cheng | Psychiatry & Neurology | 3915 Talbot Rd S, Ste 104, Renton, WA 98055-5738 | 2007-05-24 |
| 1730207143 | Chang B. Shin | Psychiatry & Neurology | 4300 Talbot Rd S, Suite 303, Renton, WA 98055-6238 | 2007-03-26 |
| 1023103033 | Don Q. Thai | Psychiatry & Neurology | 3915 Talbot Rd S, Ste 104, Renton, WA 98055-5738 | 2006-10-04 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.