Healthcare Provider Details

I. General information

NPI: 1184396962
Provider Name (Legal Business Name): KWANG-SEOK KANG MS-IPC, A-IPC, CIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1090
US

IV. Provider business mailing address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1090
US

V. Phone/Fax

Practice location:
  • Phone: 518-580-2687
  • Fax: 518-580-4238
Mailing address:
  • Phone: 518-920-7836
  • Fax: 518-580-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number220542
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number220542
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number220542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: