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General NPI Number Information
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NPI Number | 1720281421
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Entity Type | Organization
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Legal Business Name | HEA SHIN KANG PHYSICIAN P.C.
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 14308 ROOSEVELT AVE SUITE L2
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City | FLUSHING
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State | NY
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Zip | 11354-6146
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Country | US
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Telephone | 718-888-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 14308 ROOSEVELT AVE SUITE L2
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City | FLUSHING
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State | NY
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Zip | 11354-6146
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Country | US
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Telephone | 718-888-0502
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEA SHIN KANG
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Credential | M.D.
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Telephone | 718-888-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 231325
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License Number State | NY
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