Healthcare Provider Details

I. General information

NPI: 1245750520
Provider Name (Legal Business Name): SEONGRAK KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 SANFORD AVE
FLUSHING NY
11355-1358
US

IV. Provider business mailing address

42 FLOWER LN
JERICHO NY
11753-2312
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-6268
  • Fax:
Mailing address:
  • Phone: 201-759-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number041675
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: