Healthcare Provider Details

I. General information

NPI: 1548153190
Provider Name (Legal Business Name): DEBORAH MINJOO KANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MIDLAND AVE STE 1A
PARAMUS NJ
07652-2926
US

IV. Provider business mailing address

15 E MIDLAND AVE STE 1A
PARAMUS NJ
07652-2926
US

V. Phone/Fax

Practice location:
  • Phone: 201-599-8000
  • Fax: 201-599-8003
Mailing address:
  • Phone: 201-599-8000
  • Fax: 201-599-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00938900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: