Provider Demographics
NPI:1942523246
Name:KONG, MIHYUN
Entity Type:Individual
Prefix:
First Name:MIHYUN
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3809
Mailing Address - Country:US
Mailing Address - Phone:718-932-8544
Mailing Address - Fax:718-932-4333
Practice Address - Street 1:3355 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-3809
Practice Address - Country:US
Practice Address - Phone:718-932-8544
Practice Address - Fax:718-932-4333
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist