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General NPI Number Information
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NPI Number | 1083379416
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Entity Type | Individual
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Provider Name | JINYOUNG KIM PT, L.AC.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 22304 56TH RD FL 2
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City | BAYSIDE
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State | NY
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Zip | 11364-2040
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Country | US
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Telephone | 201-732-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 22304 56TH RD FL 2
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City | BAYSIDE
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State | NY
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Zip | 11364-2040
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Country | US
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Telephone | 201-732-3333
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 007726
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 042377
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License Number State | NY
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