Provider Demographics
NPI:1558809780
Name:KANG, DANIEL DONGHYUN (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DONGHYUN
Last Name:KANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14745 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3756
Mailing Address - Country:US
Mailing Address - Phone:929-213-3171
Mailing Address - Fax:
Practice Address - Street 1:25 EXFORD PL
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-2113
Practice Address - Country:US
Practice Address - Phone:929-213-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist