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General NPI Number Information
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NPI Number | 1013801067
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Entity Type | Individual
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Provider Name | LEONARD KIM
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1402 DUNLAWTON AVE STE 4D
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City | PORT ORANGE
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State | FL
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Zip | 32127-2918
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Country | US
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Telephone | 386-671-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 CAROLINE ST
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1205
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Country | US
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Telephone | 636-312-0785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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