Provider Demographics
NPI:1588104079
Name:KANG, SIMKEON ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:SIMKEON
Middle Name:ANDREW
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7 PATEMAN CIR
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1338
Mailing Address - Country:US
Mailing Address - Phone:240-340-4936
Mailing Address - Fax:
Practice Address - Street 1:7 PATEMAN CIR
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-1338
Practice Address - Country:US
Practice Address - Phone:240-340-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130013207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy