Healthcare Provider Details

I. General information

NPI: 1154242386
Provider Name (Legal Business Name): DI KANG MBCHB, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MADISON AVE
NEW YORK NY
10010-3643
US

IV. Provider business mailing address

33 4TH ST APT 802
BROOKLYN NY
11231-5496
US

V. Phone/Fax

Practice location:
  • Phone: 385-280-6592
  • Fax:
Mailing address:
  • Phone: 385-280-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMT19414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: