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General NPI Number Information
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NPI Number | 1619785508
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Entity Type | Individual
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Provider Name | JAEYEON KANG
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Gender | Female
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 212-241-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 160 E 91ST ST APT 6E
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City | NEW YORK
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State | NY
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Zip | 10128-2465
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Country | US
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Telephone | 201-714-1917
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F311929
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License Number State | NY
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