Healthcare Provider Details

I. General information

NPI: 1184034878
Provider Name (Legal Business Name): STELLA KYUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BO SUN KYUNG

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 877-426-5637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number340288
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number340288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: