Provider Demographics
NPI:1346354800
Name:YU, KANG (MD)
Entity Type:Individual
Prefix:
First Name:KANG
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1437
Mailing Address - Country:US
Mailing Address - Phone:315-539-1980
Mailing Address - Fax:315-539-1054
Practice Address - Street 1:12 N PARK ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1437
Practice Address - Country:US
Practice Address - Phone:315-539-1980
Practice Address - Fax:315-539-1054
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1102902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110290Medicaid
NY110290Medicaid