=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205644754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANGJEUNG KIM PHYSICAL THERAPY. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2024
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 MADISON AVE FL 4
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-916-6941
-----------------------------------------------------
Fax | 917-905-4370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3432 97TH ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SANGJEUNG KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-770-0019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------