Healthcare Provider Details

I. General information

NPI: 1407167984
Provider Name (Legal Business Name): DR. SUNG-AH KIM KEPPEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

2535 KING LEAR DR APT #6
MONROEVILLE PA
15146-3449
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax: 814-472-1105
Mailing address:
  • Phone: 412-651-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020642
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: