Provider Demographics
NPI:1427134154
Name:KANG, HYUNWON (RPT)
Entity type:Individual
Prefix:MR
First Name:HYUNWON
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16326 NORTHERN BLVD
Mailing Address - Street 2:FL 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2645
Mailing Address - Country:US
Mailing Address - Phone:718-358-4080
Mailing Address - Fax:718-358-4090
Practice Address - Street 1:16326 NORTHERN BLVD
Practice Address - Street 2:FL 1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2645
Practice Address - Country:US
Practice Address - Phone:718-358-4080
Practice Address - Fax:718-358-4090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02582612Medicaid
NY06755GMedicare ID - Type Unspecified