MEDICARE: BO-KWAN KANG PT, DPT

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	225100000X	Physical Therapist	030096	NY

General Provider Information

NPI Number	:	1649414046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BO-KWAN KANG PT, DPT

Provider Business Mailing Address
First Line	:	13620 MAPLE AVE STE 501
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5167
Country	:	US
Telephone Number	:	718-799-0876
Fax Number	:	917-588-2811

Provider Business Practice Location Address
First Line	:	13620 MAPLE AVE STE 501
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5167
Country	:	US
Telephone Number	:	718-799-0876
Fax Number	:	917-588-2811

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	03/04/2025

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