Provider Demographics
NPI:1184617326
Name:LOYCHUSUK, KITTI (MD)
Entity type:Individual
Prefix:MR
First Name:KITTI
Middle Name:
Last Name:LOYCHUSUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 3 SUITE D
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-475-7030
Mailing Address - Fax:631-475-2905
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 3 SUITE D
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-7030
Practice Address - Fax:631-475-2905
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY118300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12903Medicare UPIN
NY32A061Medicare ID - Type Unspecified