Provider Demographics
NPI:1437210812
Name:KANG, MIMI Y (MD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:Y
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S BEDFORD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3441
Mailing Address - Country:US
Mailing Address - Phone:914-241-4900
Mailing Address - Fax:914-241-4976
Practice Address - Street 1:105 S BEDFORD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3441
Practice Address - Country:US
Practice Address - Phone:914-241-4900
Practice Address - Fax:914-241-4976
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1972951207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57Z871Medicare PIN
G41932Medicare UPIN