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General NPI Number Information
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NPI Number | 1306375258
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Entity Type | Individual
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Provider Name | JESSIE KIM
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 115 W 45TH ST STE 503
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City | NEW YORK
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State | NY
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Zip | 10036-4005
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Country | US
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Telephone | 646-983-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 207 HALLOCK RD STE 209
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City | STONY BROOK
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State | NY
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Zip | 11790-3082
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Country | US
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Telephone | 631-338-8516
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Fax | 518-984-3120
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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 | 034901
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License Number State | NY
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