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General NPI Number Information
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NPI Number | 1255924254
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Entity Type | Individual
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Provider Name | SANGJEUNG KIM
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Gender | Male
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 605 MADISON AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10022-1738
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Country | US
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Telephone | 760-916-6941
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Fax | 917-905-4370
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Provider Business Mailing Address
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Address Line | 3432 97TH ST
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City | FLUSHING
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State | NY
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Zip | 11368-1032
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Country | US
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Telephone | 760-916-6941
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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 | 299931
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA02235700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 048051-01
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License Number State | NY
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