Provider Demographics
NPI:1528188505
Name:KANG, WEON HI (NP)
Entity type:Individual
Prefix:
First Name:WEON HI
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5832
Mailing Address - Country:US
Mailing Address - Phone:718-762-1710
Mailing Address - Fax:718-762-1753
Practice Address - Street 1:3834 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5832
Practice Address - Country:US
Practice Address - Phone:718-762-1710
Practice Address - Fax:718-762-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445736374T00000X
NY334486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02738058Medicaid