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General NPI Number Information
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NPI Number | 1508180779
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Entity Type | Individual
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Provider Name | KANG H KO S.P
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Gender | Male
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 6319 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-3641
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Country | US
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Telephone | 718-429-2140
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Fax | 718-565-5987
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Provider Business Mailing Address
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Address Line | 62-10 WOODSIDE AVE SUITE NO. 312
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 718-565-8354
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Fax | 718-565-5987
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 30867
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License Number State | NY
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