MEDICARE: KYONGHYUN KO PT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1831137926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYONGHYUN KO PT

Provider Business Mailing Address
First Line	:	3518 150TH PL FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	718-445-4370
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 150TH PL FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	718-445-4370
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/29/2022

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Directions to “ KYONGHYUN KO PT” Practice Location

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