MEDICARE: SUJIN 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841931342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJIN KANG

Provider Business Mailing Address
First Line	:	17163 46TH AVE # 2RR
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17163 46TH AVE # 2RR
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3332
Country	:	US
Telephone Number	:	917-566-6610
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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Directions to “ SUJIN KANG ” Practice Location

Language	Start Address	Practice Location

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