Provider Demographics
NPI:1528013091
Name:KANG, HEA-SHIN (MD)
Entity Type:Individual
Prefix:
First Name:HEA-SHIN
Middle Name:
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 1:143-08 ROOSEVELT AVE
Mailing Address - Street 2:#L-2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-0502
Mailing Address - Fax:718-888-0725
Practice Address - Street 1:143-08 ROOSEVELT AVE
Practice Address - Street 2:#L-2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-0502
Practice Address - Fax:718-888-0725
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01782865Medicaid
NY01782865Medicaid
NY06733GMedicare PIN