Healthcare Provider Details

I. General information

NPI: 1801702147
Provider Name (Legal Business Name): DAVID KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SUMMIT AVE FL 2
HACKENSACK NJ
07601-1262
US

IV. Provider business mailing address

87 SUMMIT AVE FL 2
HACKENSACK NJ
07601-1262
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-9110
  • Fax:
Mailing address:
  • Phone: 201-880-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02432600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: