=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558916684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TZU YU KAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2019
-----------------------------------------------------
Last Update Date | 10/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 CLASSON AVE.
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-587-0165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 8TH STREET APT B
-----------------------------------------------------
City | PALISADES PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 011467
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------