Provider Demographics
NPI:1093963134
Name:KAM, YI SHENG (DO)
Entity Type:Individual
Prefix:DR
First Name:YI SHENG
Middle Name:
Last Name:KAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24812 NORTHERN BLVD
Mailing Address - Street 2:2A
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1206
Mailing Address - Country:US
Mailing Address - Phone:718-281-3028
Mailing Address - Fax:718-281-3029
Practice Address - Street 1:24812 NORTHERN BLVD
Practice Address - Street 2:2A
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1206
Practice Address - Country:US
Practice Address - Phone:718-281-3028
Practice Address - Fax:718-281-3029
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
286500000X
NY262586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN