MEDICARE: JONGHO KIM

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	6893	NV

General Provider Information

NPI Number	:	1477417624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONGHO KIM

Provider Business Mailing Address
First Line	:	68 NORTHERN PKWY W
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-2932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WIGWAM PKWY STE 240
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8195
Country	:	US
Telephone Number	:	702-568-0195
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ JONGHO KIM ” Practice Location

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