Provider Demographics
NPI:1174825749
Name:KANG, KEUN SUNG
Entity type:Individual
Prefix:MR
First Name:KEUN SUNG
Middle Name:
Last Name:KANG
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 1:34-24 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3053
Mailing Address - Country:US
Mailing Address - Phone:718-877-1435
Mailing Address - Fax:718-463-5525
Practice Address - Street 1:34-24 UNION STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3053
Practice Address - Country:US
Practice Address - Phone:718-877-1435
Practice Address - Fax:718-463-5525
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000019486237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter