Healthcare Provider Details

I. General information

NPI: 1235658576
Provider Name (Legal Business Name): JASMINE KUAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 60TH ST APT 2A
NEW YORK NY
10023-8503
US

IV. Provider business mailing address

200 W 60TH ST APT 2A
NEW YORK NY
10023-8503
US

V. Phone/Fax

Practice location:
  • Phone: 917-771-6311
  • Fax:
Mailing address:
  • Phone: 917-771-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number041563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: