Provider Demographics
NPI:1134248594
Name:JACKSON H. KUAN M.D. LLC
Entity type:Organization
Organization Name:JACKSON H. KUAN M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-358-3535
Mailing Address - Street 1:13259 41ST RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4257
Mailing Address - Country:US
Mailing Address - Phone:718-358-3535
Mailing Address - Fax:718-358-2072
Practice Address - Street 1:13259 41ST RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4257
Practice Address - Country:US
Practice Address - Phone:718-358-3535
Practice Address - Fax:718-358-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05717GMedicare ID - Type Unspecified
NYD92199Medicare UPIN