MEDICARE: BRIAN ALEXANDER KIM DPT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1366157547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ALEXANDER KIM DPT

Provider Business Mailing Address
First Line	:	14703 WILLETS POINT BLVD
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3544
Country	:	US
Telephone Number	:	646-915-4558
Fax Number	:

Provider Business Practice Location Address
First Line	:	14703 WILLETS POINT BLVD
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3544
Country	:	US
Telephone Number	:	646-915-4558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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