Provider Demographics
NPI:1972778280
Name:KYNAM INC
Entity Type:Organization
Organization Name:KYNAM INC
Other - Org Name:STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EUN JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-677-2519
Mailing Address - Street 1:8941 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8941 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1537
Practice Address - Country:US
Practice Address - Phone:718-205-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028848333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6116980001Medicare NSC