Provider Demographics
NPI:1508833872
Name:KAN, SANG (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:
Last Name:KAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BOWERY ST
Mailing Address - Street 2:2ND FLOOR, SUITE 8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6702
Mailing Address - Country:US
Mailing Address - Phone:212-226-2251
Mailing Address - Fax:
Practice Address - Street 1:19 BOWERY ST
Practice Address - Street 2:2ND FLOOR, SUITE 8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6702
Practice Address - Country:US
Practice Address - Phone:212-226-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177888Medicaid
NY04875Medicare ID - Type Unspecified
NY014AC1Medicare ID - Type Unspecified
NY02177888Medicaid