Provider Demographics
NPI:1245750520
Name:KANG, SEONGRAK
Entity type:Individual
Prefix:
First Name:SEONGRAK
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2312
Mailing Address - Country:US
Mailing Address - Phone:201-759-6500
Mailing Address - Fax:
Practice Address - Street 1:42-12 164TH ST 1FL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-701-5500
Practice Address - Fax:718-888-1524
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006874171100000X
NY041675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist