Provider Demographics
NPI:1992114656
Name:METROPOLITAN OTOLARYNGOLOGY & FACIAL PLASTICS PC
Entity type:Organization
Organization Name:METROPOLITAN OTOLARYNGOLOGY & FACIAL PLASTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-939-6050
Mailing Address - Street 1:4103 UNION ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2452
Mailing Address - Country:US
Mailing Address - Phone:718-939-6050
Mailing Address - Fax:718-939-6047
Practice Address - Street 1:4103 UNION ST
Practice Address - Street 2:2ND FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2452
Practice Address - Country:US
Practice Address - Phone:718-939-6050
Practice Address - Fax:718-939-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02401Medicare UPIN