MEDICARE: FOUR SEASON MEDICAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	174400000X	Specialist
3	207Q00000X	Family Medicine Physician
4	363LA2200X	Adult Health Nurse Practitioner
5	207R00000X	Internal Medicine Physician	214116	NY

General Provider Information

NPI Number	:	1447785316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SEASON MEDICAL PLLC

Provider Business Mailing Address
First Line	:	837 59TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3611
Country	:	US
Telephone Number	:	718-680-8881
Fax Number	:	718-680-7880

Provider Business Practice Location Address
First Line	:	2041 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3203
Country	:	US
Telephone Number	:	718-680-8881
Fax Number	:	718-680-7880

Authorized Official
Title or Position	:	M.D
Name	:	DR. YONG KANG HE
Credential	:	M.D
Telephone Number	:	718-680-8881

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/04/2022

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Directions to “FOUR SEASON MEDICAL PLLC ” Practice Location

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