=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508833872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANG KAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2006
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13527 38TH AVE FL 2
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-4449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-886-5068
-----------------------------------------------------
Fax | 718-886-5972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 BOWERY FL 7
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-226-2251
-----------------------------------------------------
Fax | 888-502-8168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 222522
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------