Provider Demographics
NPI:1639621493
Name:BK MEDICAL, P.C
Entity Type:Organization
Organization Name:BK MEDICAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HEEBAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-757-1141
Mailing Address - Street 1:1664 E 14TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1167
Mailing Address - Country:US
Mailing Address - Phone:718-747-4302
Mailing Address - Fax:
Practice Address - Street 1:1664 E 14TH ST STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1167
Practice Address - Country:US
Practice Address - Phone:718-747-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098648A2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty