Provider Demographics
NPI:1386899649
Name:L. KAN CHILD NEUROLOGY, P.C.
Entity type:Organization
Organization Name:L. KAN CHILD NEUROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-9443
Mailing Address - Street 1:PO BOX 630360
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-0360
Mailing Address - Country:US
Mailing Address - Phone:718-888-9443
Mailing Address - Fax:888-749-6861
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:STE 7B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4277
Practice Address - Country:US
Practice Address - Phone:718-888-9443
Practice Address - Fax:888-749-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202310204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH74721Medicare UPIN