Provider Demographics
NPI:1174555486
Name:HE, YONG KANG
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:KANG
Last Name:HE
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 1:351 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5011
Mailing Address - Country:US
Mailing Address - Phone:212-966-8216
Mailing Address - Fax:212-966-8217
Practice Address - Street 1:77 BOWERY FL 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4955
Practice Address - Country:US
Practice Address - Phone:212-966-8216
Practice Address - Fax:212-966-8217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069239207R00000X
NY214116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02023389Medicaid
NY51C882Medicare Oscar/Certification