Healthcare Provider Details

I. General information

NPI: 1427245380
Provider Name (Legal Business Name): SEUNG SHIN KANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BLDG 600B
MIAMI FL
33136-1005
US

IV. Provider business mailing address

8724 SW 72ND ST # 442
MIAMI FL
33173-3512
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6856
  • Fax: 305-355-2244
Mailing address:
  • Phone: 954-800-4400
  • Fax: 754-206-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS10180
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS10180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: