Healthcare Provider Details

I. General information

NPI: 1750820304
Provider Name (Legal Business Name): HANA ADULT DAY CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21425 42ND AVE STE 2R
BAYSIDE NY
11361-2586
US

IV. Provider business mailing address

21425 42ND AVE STE 2R
BAYSIDE NY
11361-2586
US

V. Phone/Fax

Practice location:
  • Phone: 917-285-2757
  • Fax: 917-285-2382
Mailing address:
  • Phone: 917-285-2757
  • Fax: 917-285-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: WOO KIM
Title or Position: DIRECTOR
Credential:
Phone: 917-285-2757