Provider Demographics
NPI:1164872388
Name:KANG, HYOHUN
Entity Type:Individual
Prefix:
First Name:HYOHUN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 158TH ST
Mailing Address - Street 2:2FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3143
Mailing Address - Country:US
Mailing Address - Phone:917-900-8957
Mailing Address - Fax:
Practice Address - Street 1:14304 38TH AVE
Practice Address - Street 2:1FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5742
Practice Address - Country:US
Practice Address - Phone:917-900-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist