Provider Demographics
NPI:1467094631
Name:POON, CHUN KIT (PA-C)
Entity Type:Individual
Prefix:
First Name:CHUN KIT
Middle Name:
Last Name:POON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4834 206TH ST # 1F
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1050
Mailing Address - Country:US
Mailing Address - Phone:646-703-3951
Mailing Address - Fax:
Practice Address - Street 1:4834 206TH ST # 1F
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-1050
Practice Address - Country:US
Practice Address - Phone:646-703-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant