# KINGS PARK MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609200716
- **Authorized official:** WEYMIN G HAGO MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (631) 292-2725

## Contact information

- **Practice address:** 93 MAIN ST, SUITE A, KINGS PARK, NY 11754-2740
- **Practice address phone:** (631) 292-2725
- **Practice address fax:** (631) 292-2727
- **Mailing address:** 93 MAIN ST, SUITE A, KINGS PARK, NY 11754-2740
- **Mailing address phone:** (631) 292-2725
- **Mailing address fax:** (631) 292-2727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 258181-1 | NY | Yes |

## Other

- **Enumeration date:** 08/26/2013
- **Last updated:** 08/26/2013