Healthcare Provider Details

I. General information

NPI: 1164411534
Provider Name (Legal Business Name): HYEON-SUK KIM LAWTER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HHC 121ST GENERAL HOSPITAL BOX 355
APO AP
96205
KR

IV. Provider business mailing address

HHC 121ST GENERAL HOSPITAL BOX 355
APO AP
96205
KR

V. Phone/Fax

Practice location:
  • Phone: 736
  • Fax: 7384432
Mailing address:
  • Phone: 736
  • Fax: 7384432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: