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General NPI Number Information
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NPI Number | 1972110476
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Entity Type | Individual
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Provider Name | YONG KIM DPT
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Gender | Male
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 101 UNIVERSITY DR STE A6
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City | AMHERST
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State | MA
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Zip | 01002-2385
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Country | US
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Telephone | 413-366-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 843-824-2183
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Fax | 843-553-3221
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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 | 25072
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License Number State | MA
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