Provider Demographics
NPI:1699152181
Name:KANG, RAI YEON (DPM)
Entity type:Individual
Prefix:DR
First Name:RAI YEON
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 GALWAY PL STE 300
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3640
Mailing Address - Country:US
Mailing Address - Phone:201-833-9500
Mailing Address - Fax:201-862-0095
Practice Address - Street 1:663 PALISADE AVE STE 302
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-833-9500
Practice Address - Fax:201-862-0095
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00342800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery