Provider Demographics
NPI:1952034233
Name:KANG, SU IL (PA-C)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:IL
Last Name:KANG
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1055 47TH AVE APT 7E
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5445
Mailing Address - Country:US
Mailing Address - Phone:240-472-2245
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1197
Practice Address - Country:US
Practice Address - Phone:718-918-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-08-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant