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General NPI Number Information
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NPI Number | 1386113819
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Entity Type | Individual
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Provider Name | MANSOO KIM
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Gender | Male
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 139 CENTRE ST STE 507
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City | NEW YORK
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State | NY
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Zip | 10013-4555
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Country | US
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Telephone | 718-353-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 186 TENNEY AVE
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2234
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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 | 033109
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 6765
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License Number State | NY
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