Provider Demographics
NPI:1356553549
Name:KANGHAN MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:KANGHAN MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-762-3240
Mailing Address - Street 1:38-34 PARSONS BLVD.
Mailing Address - Street 2:SUITE# 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6126
Mailing Address - Country:US
Mailing Address - Phone:718-762-3240
Mailing Address - Fax:718-732-3039
Practice Address - Street 1:19214 NORTHERN BLVD STE 2D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2955
Practice Address - Country:US
Practice Address - Phone:718-762-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02245623Medicaid
NY07338Medicare PIN
NY02245623Medicaid