Provider Demographics
NPI:1851730295
Name:KAN, JING (PT)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-12B 224TH ST.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11364-0000
Mailing Address - Country:US
Mailing Address - Phone:703-220-9825
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1109
Practice Address - Country:US
Practice Address - Phone:703-220-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist