Provider Demographics
NPI:1841395100
Name:KUAN, JACKSON HSUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:HSUN
Last Name:KUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13259 41 RD
Mailing Address - Street 2:SUITE 1A AND 1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-358-3535
Mailing Address - Fax:718-358-2072
Practice Address - Street 1:13259 41 RD
Practice Address - Street 2:SUITE 1A AND 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-358-3535
Practice Address - Fax:718-358-2072
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173042207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1132241Medicaid
NY05717GMedicare ID - Type Unspecified
D92199Medicare UPIN