MEDICARE: LEONARD KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1013801067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD KIM

Provider Business Mailing Address
First Line	:	3121 CAROLINE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1205
Country	:	US
Telephone Number	:	636-312-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 DUNLAWTON AVE STE 4D
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2918
Country	:	US
Telephone Number	:	386-671-2626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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Directions to “ LEONARD KIM ” Practice Location

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