Provider Demographics
NPI:1649414046
Name:KANG, BO-KWAN
Entity Type:Individual
Prefix:
First Name:BO-KWAN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 GRAND ST
Mailing Address - Street 2:2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4408
Mailing Address - Country:US
Mailing Address - Phone:347-749-3123
Mailing Address - Fax:718-709-4176
Practice Address - Street 1:285 GRAND ST
Practice Address - Street 2:2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4408
Practice Address - Country:US
Practice Address - Phone:347-749-3123
Practice Address - Fax:718-709-4176
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030096261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy