Individual provider Active NPI

Amy Ye-Eun Kang, FNP-C

  • Family Nurse Practitioner
  • Maitland, FL
National Provider Identifier
1740056522
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11029924 Issued in FL
Practice address
2400 Maitland Center Pkwy Ste 310
Maitland, FL 32751-7442
Phone
(407) 426-4800
Fax
(407) 426-4820
NPI assigned
Dec 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11029924 FL Primary

Addresses

Primary practice location

2400 Maitland Center Pkwy Ste 310
Maitland, FL 32751-7442

Mailing address

2400 Maitland Center Pkwy Ste 310
Maitland, FL 32751-7442
Phone (407) 426-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240606000831 FL Practitioner - Nurse Practitioner 8426590472

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11029924FLMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1740056522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MAITLAND CENTER PKWY STE 310",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517442",
            "telephone_number": "407-426-4800",
            "fax_number": "407-426-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MAITLAND CENTER PKWY STE 310",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517442",
            "telephone_number": "407-426-4800",
            "fax_number": "407-426-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "AMY",
        "middle_name": "YE-EUN",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11029924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.