MEDICARE: BK MEDICAL, P.C

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	098648A	NY

General Provider Information

NPI Number	:	1639621493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BK MEDICAL, P.C

Provider Business Mailing Address
First Line	:	1664 E 14TH ST STE 302
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1167
Country	:	US
Telephone Number	:	718-747-4302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 E 14TH ST STE 302
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1167
Country	:	US
Telephone Number	:	718-747-4302
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	HEEBAE KONG
Credential	:
Telephone Number	:	917-757-1141

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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