Healthcare Provider Details

I. General information

NPI: 1497660328
Provider Name (Legal Business Name): SANGMIN KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 SANFORD AVE FL 1
FLUSHING NY
11355-1358
US

IV. Provider business mailing address

14714 SANFORD AVE FL 1
FLUSHING NY
11355-1358
US

V. Phone/Fax

Practice location:
  • Phone: 706-300-5970
  • Fax:
Mailing address:
  • Phone: 706-300-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: