Provider Demographics
NPI:1063562957
Name:PI, KAIDUAN (MD)
Entity type:Individual
Prefix:
First Name:KAIDUAN
Middle Name:
Last Name:PI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-7529
Mailing Address - Country:US
Mailing Address - Phone:516-242-0424
Mailing Address - Fax:516-674-7079
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-242-0424
Practice Address - Fax:615-674-7079
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02337997Medicaid
NY928631Medicare ID - Type Unspecified
NY02337997Medicaid