Provider Demographics
NPI:1043359375
Name:KANG, SEONGSHIK (MS PT LAC)
Entity type:Individual
Prefix:
First Name:SEONGSHIK
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:MS PT LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-10 BOWNE ST
Mailing Address - Street 2:#L1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-353-3836
Mailing Address - Fax:718-353-3837
Practice Address - Street 1:41-10 BOWNE ST
Practice Address - Street 2:#L1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-353-3836
Practice Address - Fax:718-353-3837
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002262171100000X
NY014833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02751811Medicaid
NY02751811Medicaid
NY05676Medicare PIN