Healthcare Provider Details

I. General information

NPI: 1043469042
Provider Name (Legal Business Name): JUN KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 55TH ST FL 1
BROOKLYN NY
11220-3213
US

IV. Provider business mailing address

818 55TH ST FL 1
BROOKLYN NY
11220-3213
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-6868
  • Fax: 718-972-2588
Mailing address:
  • Phone: 718-972-6868
  • Fax: 718-972-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number259610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: