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NPI Code Detail

MEDICARE: JAMES W KIM PT, DPT

MEDICARE: JAMES W KIM PT, 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
1225100000XPhysical TherapistPT872545DC

General Provider Information

NPI Number : 1366902017
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES W KIM PT, DPT
Provider Business Mailing Address
First Line : 350 NEW FIDELITY CT
Second Line :
City : GARNER
State : NC
Zip : 27529-2665
Country : US
Telephone Number : 919-258-2714
Fax Number : 410-648-4878
Provider Business Practice Location Address
First Line : 5353 N 16TH ST STE 120
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-3282
Country : US
Telephone Number : 602-826-0037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 11/07/2019

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