Healthcare Provider Details

I. General information

NPI: 1336298835
Provider Name (Legal Business Name): EUNSOOK BANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14703 41ST AVE 1ST FLOOR
FLUSHING NY
11355-1248
US

IV. Provider business mailing address

147-03 41ST AVE
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7793
  • Fax: 718-461-0324
Mailing address:
  • Phone: 718-762-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number152456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: