MEDICARE: KEVIN SHING KAM

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	111N00000X	Chiropractor	X013189	NY

General Provider Information

NPI Number	:	1932670320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SHING KAM

Provider Business Mailing Address
First Line	:	1441 BROADWAY STE 5052
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-1905
Country	:	US
Telephone Number	:	646-309-8999
Fax Number	:	718-866-1097

Provider Business Practice Location Address
First Line	:	1441 BROADWAY STE 5052
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-1905
Country	:	US
Telephone Number	:	646-309-8999
Fax Number	:	718-866-1097

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	06/28/2021

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