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General NPI Number Information
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NPI Number | 1861881872
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Entity Type | Organization
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Legal Business Name | KANG LAN MEDICAL PLLC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 4211 PARSONS BLVD APT 4B
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City | FLUSHING
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State | NY
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Zip | 11355-2150
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Country | US
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Telephone | 347-925-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S MIDDLE NECK RD APT K3
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City | GREAT NECK
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State | NY
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Zip | 11021-4650
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Country | US
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Telephone | 347-925-2950
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SUMMER RUONAN ZHANG
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Credential | MD
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Telephone | 347-925-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 263074
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License Number State | NY
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