Provider Demographics
NPI:1689099293
Name:LIEVANO, KANGMEI (DO)
Entity Type:Individual
Prefix:DR
First Name:KANGMEI
Middle Name:
Last Name:LIEVANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 GREYSTONE AVE
Mailing Address - Street 2:2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:BREAKER BUILDING - ROOM 407
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6240
Practice Address - Fax:718-960-6125
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2392207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine