MEDICARE: NIKKI KANG

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1689430175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI KANG

Provider Business Mailing Address
First Line	:	9426 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9426 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1222
Country	:	US
Telephone Number	:	917-344-0204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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Directions to “ NIKKI KANG ” Practice Location

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