MEDICARE: JULIANNE KIM P.T.

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	031187	NY

General Provider Information

NPI Number	:	1922232081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE KIM P.T.

Provider Business Mailing Address
First Line	:	14055 34TH AVE
Second Line	:	#3M
City	:	FLUSHING
State	:	NY
Zip	:	11354-3055
Country	:	US
Telephone Number	:	718-358-3297
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 LENOX AVE
Second Line	:	ROOM 3137
City	:	NEW YORK
State	:	NY
Zip	:	10037-1802
Country	:	US
Telephone Number	:	212-939-4442
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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