MEDICARE: MR. HYUNWON KANG RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	016019	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427134154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HYUNWON KANG RPT

Provider Business Mailing Address
First Line	:	16326 NORTHERN BLVD
Second Line	:	FL 1
City	:	FLUSHING
State	:	NY
Zip	:	11358-2645
Country	:	US
Telephone Number	:	718-358-4080
Fax Number	:	718-358-4090

Provider Business Practice Location Address
First Line	:	16326 NORTHERN BLVD
Second Line	:	FL 1
City	:	FLUSHING
State	:	NY
Zip	:	11358-2645
Country	:	US
Telephone Number	:	718-358-4080
Fax Number	:	718-358-4090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/10/2018

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