Healthcare Provider Details

I. General information

NPI: 1922330539
Provider Name (Legal Business Name): MR. SHIN KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13698 ROOSEVELT AVE
FLUSHING NY
11354-5510
US

IV. Provider business mailing address

3316 255TH ST
LITTLE NECK NY
11363-1413
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-5500
  • Fax:
Mailing address:
  • Phone: 718-281-1537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029886
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number029886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: