Provider Demographics
NPI:1528094349
Name:KUANG, GORDON (DC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:KUANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5340
Mailing Address - Country:US
Mailing Address - Phone:516-208-3570
Mailing Address - Fax:
Practice Address - Street 1:166 5TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5909
Practice Address - Country:US
Practice Address - Phone:212-675-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010843-3111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7N161Medicare ID - Type Unspecified
NYV01984Medicare UPIN