Healthcare Provider Details

I. General information

NPI: 1518007368
Provider Name (Legal Business Name): DAVID KANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 JAMES ST
SYRACUSE NY
13203-2703
US

IV. Provider business mailing address

620 MADISON ST
SYRACUSE NY
13210-2319
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-4471
  • Fax: 315-472-1759
Mailing address:
  • Phone: 315-426-3630
  • Fax: 315-426-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number242014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: