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General NPI Number Information
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NPI Number | 1134768005
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Entity Type | Individual
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Provider Name | YOUNGKI KONG
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Gender | Male
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Dates
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Enumeration Date | 12/24/2019
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 4322 50TH ST STE 1B
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City | WOODSIDE
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State | NY
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Zip | 11377-4442
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Country | US
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Telephone | 718-424-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 158TH ST APT 2E
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City | FLUSHING
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State | NY
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Zip | 11358-3166
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40053
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License Number State | NY
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