Healthcare Provider Details

I. General information

NPI: 1841395100
Provider Name (Legal Business Name): JACKSON HSUN KUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13259 41 RD SUITE 1A AND 1B
FLUSHING NY
11355
US

IV. Provider business mailing address

13259 41 RD SUITE 1A AND 1B
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-3535
  • Fax: 718-358-2072
Mailing address:
  • Phone: 718-358-3535
  • Fax: 718-358-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number173042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: