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General NPI Number Information
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NPI Number | 1619353935
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Entity Type | Individual
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Provider Name | KYUNGSIK JAMES YANG
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Gender | Male
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 121 E 60TH ST APT 11A
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City | NEW YORK
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State | NY
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Zip | 10022-1198
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Country | US
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Telephone | 212-755-4833
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 AVENUE AT PORT IMPERIAL APT 840
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City | WEEHAWKEN
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State | NJ
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Zip | 07086-6301
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Country | US
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Telephone | 201-983-1133
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 058568-1
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License Number State | NY
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