Healthcare Provider Details

I. General information

NPI: 1700701752
Provider Name (Legal Business Name): SAMANTHA KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 SHANNON RD STE 140
DURHAM NC
27707-6324
US

IV. Provider business mailing address

3211 SHANNON RD STE 140
DURHAM NC
27707-6324
US

V. Phone/Fax

Practice location:
  • Phone: 919-748-4980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP25157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: