Provider Demographics
NPI:1558943472
Name:KANG, SUKI S (FNP)
Entity Type:Individual
Prefix:
First Name:SUKI
Middle Name:S
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LITTLE NECK PKWY APT 14A
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1726
Mailing Address - Country:US
Mailing Address - Phone:631-880-0538
Mailing Address - Fax:
Practice Address - Street 1:4001 LITTLE NECK PKWY APT 14A
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1726
Practice Address - Country:US
Practice Address - Phone:631-880-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347472-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily