Healthcare Provider Details

I. General information

NPI: 1225290117
Provider Name (Legal Business Name): BELL MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 BELL BLVD
BAYSIDE NY
11361
US

IV. Provider business mailing address

4531 BELL BLVD
BAYSIDE NY
11361
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-2356
  • Fax: 718-225-0370
Mailing address:
  • Phone: 718-225-2356
  • Fax: 718-225-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number25MA04053700
License Number StateNJ

VIII. Authorized Official

Name: DR. CHANG H KANG
Title or Position: PRESIDENT
Credential: MD
Phone: 718-225-2356