Provider Demographics
NPI:1306832498
Name:INCORVATI, KYUNG K (MD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:K
Last Name:INCORVATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1520 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-2204
Mailing Address - Country:US
Mailing Address - Phone:724-843-3800
Mailing Address - Fax:724-843-4799
Practice Address - Street 1:93 BOUNDRY LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2949
Practice Address - Country:US
Practice Address - Phone:724-843-3800
Practice Address - Fax:724-843-4799
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067851L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017780330006Medicaid
PAH09276Medicare UPIN
PA034526LCKMedicare PIN