Provider Demographics
NPI:1104047455
Name:KANG, DONGHOON (LAC)
Entity type:Individual
Prefix:MR
First Name:DONGHOON
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20920 18TH AVE
Mailing Address - Street 2:#2C
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1452
Mailing Address - Country:US
Mailing Address - Phone:646-748-6329
Mailing Address - Fax:
Practice Address - Street 1:20920 18TH AVE
Practice Address - Street 2:#2C
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1452
Practice Address - Country:US
Practice Address - Phone:646-748-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist