MEDICARE: HYENA PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1316716368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYENA PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	864 GRAND AVE
Second Line	:	#98
City	:	SAN DIEGO
State	:	CA
Zip	:	92109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 GARNET AVE
Second Line	:	STE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92109
Country	:	US
Telephone Number	:	818-934-0616
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID PARK KIM
Credential	:	DPT
Telephone Number	:	818-934-0616

Provider Enumeration Date	:	01/01/2024
Last Update Date	:	06/01/2026

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