Healthcare Provider Details

I. General information

NPI: 1225959562
Provider Name (Legal Business Name): YEGIK KIM PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJI KIM PT

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 39TH ST UNIT 7
BROOKLYN NY
11232-2713
US

IV. Provider business mailing address

81 SUMMIT ST
RIDGEFIELD PARK NJ
07660-1428
US

V. Phone/Fax

Practice location:
  • Phone: 646-422-5900
  • Fax:
Mailing address:
  • Phone: 201-637-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: