Provider Demographics
NPI:1699175091
Name:KANG, MINKYUNG (FNP-C)
Entity type:Individual
Prefix:
First Name:MINKYUNG
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W 36TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7529
Mailing Address - Country:US
Mailing Address - Phone:212-695-5122
Mailing Address - Fax:
Practice Address - Street 1:229 W 36TH ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7529
Practice Address - Country:US
Practice Address - Phone:212-695-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341418363LF0000X
NJ26NJ01050400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily