GOBUIWANG KHILLY KURUSA MD
Complete NPI Record 1033069208
Student in an Organized Health Care Education/Training Program in New Hyde Park, NY
Active since January 29, 2026
Complete NPI Dataset
This page contains the complete raw NPPES record for Gobuiwang Khilly Kurusa, MD (NPI 1033069208), an individual student in an organized health care education/training program provider in New Hyde Park, NY. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1033069208 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: KURUSA Field 3/32
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: GOBUIWANG Field 4/32
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: KHILLY Field 5/32
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: MD Field 6/32
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider Other Last Name: GASENNA Field 7/32
- Other last name by which the provider being identified is or has been known.
- Provider Other First Name: GOBUIWANG Field 8/32
- Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider first name" if the provider is or has been known by a different last name only.
- Provider Other Middle Name: KHILLY Field 9/32
- Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider middle name" if the provider is or has been known by a different last name only.
- Provider Other Credential Text: MD Field 10/32
- The other abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider Other Last Name Type Code: 1 Field 11/32
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 410 LAKEVILLE RD STE 200 Field 12/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: NEW HYDE PARK Field 13/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: NY Field 14/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 110421103 Field 15/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 16/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 5165622944 Field 17/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 5165252585 Field 18/32
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 410 LAKEVILLE RD STE 200 Field 19/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: NEW HYDE PARK Field 20/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NY Field 21/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 110421103 Field 22/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 23/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 5165622944 Field 24/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 5165252585 Field 25/32
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 28/32
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 390200000X Field 29/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 30/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 31/32
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
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