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General NPI Number Information
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NPI Number | 1598241598
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Entity Type | Individual
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Provider Name | JULIE KANG
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 2510 30TH AVE
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City | ASTORIA
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State | NY
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Zip | 11102-2448
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Country | US
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Telephone | 718-808-4382
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Fax |
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Provider Business Mailing Address
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Address Line | 3622 171ST ST # 3
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City | FLUSHING
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State | NY
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Zip | 11358-2209
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Country | US
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Telephone | 917-621-6211
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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