Provider Demographics
NPI:1184396962
Name:KANG, KWANG-SEOK (BA-HS, RPHT, CIC)
Entity type:Individual
Prefix:
First Name:KWANG-SEOK
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:BA-HS, RPHT, CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2507
Mailing Address - Country:US
Mailing Address - Phone:518-779-9955
Mailing Address - Fax:
Practice Address - Street 1:1270 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2104
Practice Address - Country:US
Practice Address - Phone:838-218-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 390200000X, 246ZB0600X
NY000243-01183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZB0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiostatistician
No174H00000XOther Service ProvidersHealth Educator
No183700000XPharmacy Service ProvidersPharmacy Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program