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General NPI Number Information
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NPI Number | 1982264958
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Entity Type | Individual
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Provider Name | YONG BEOM KIM PT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 50 E 42ND ST RM 1501A
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City | NEW YORK
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State | NY
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Zip | 10017-5423
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Country | US
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Telephone | 201-466-2046
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Fax |
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Provider Business Mailing Address
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Address Line | 19515B 67TH AVE APT 2B
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3925
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Country | US
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Telephone | 201-466-2046
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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 | 041399
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License Number State | NY
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