Provider Demographics
NPI:1508833872
Name:KAN, SANG (MD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:
Last Name:KAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BOWERY FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4615
Mailing Address - Country:US
Mailing Address - Phone:212-226-2251
Mailing Address - Fax:888-502-8168
Practice Address - Street 1:13527 38TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4449
Practice Address - Country:US
Practice Address - Phone:718-886-5068
Practice Address - Fax:718-886-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177888Medicaid
NY04875Medicare ID - Type Unspecified
NY014AC1Medicare ID - Type Unspecified
NY02177888Medicaid