| NPI | 1720445638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R KANG Owner 917-331-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX P8484) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX P8484) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-05-26 |