Provider Demographics
NPI:1801172333
Name:DENG, KEVIN (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DENG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:YU NING
Other - Middle Name:
Other - Last Name:DENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6435 181ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2141
Mailing Address - Country:US
Mailing Address - Phone:646-305-9096
Mailing Address - Fax:
Practice Address - Street 1:6435 181ST ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2141
Practice Address - Country:US
Practice Address - Phone:646-305-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021245-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist