Provider Demographics
NPI:1932670320
Name:KAM, KEVIN SHING
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SHING
Last Name:KAM
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 1:1441 BROADWAY STE 5052
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1905
Mailing Address - Country:US
Mailing Address - Phone:646-309-8999
Mailing Address - Fax:718-866-1097
Practice Address - Street 1:1441 BROADWAY STE 5052
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1905
Practice Address - Country:US
Practice Address - Phone:646-309-8999
Practice Address - Fax:718-866-1097
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor