Healthcare Provider Details

I. General information

NPI: 1164371332
Provider Name (Legal Business Name): KM PHYSICAL THERAPY & ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 PARSONS BLVD UNIT L1&2
FLUSHING NY
11354-5938
US

IV. Provider business mailing address

3625 PARSONS BLVD UNIT L1&2
FLUSHING NY
11354-5938
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KI TAE MAENG
Title or Position: LAC/PRESIDENT
Credential:
Phone: 718-353-7575