MEDICARE: YOOHYUN 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	032720	NY

General Provider Information

NPI Number	:	1922423656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOOHYUN KIM DPT

Provider Business Mailing Address
First Line	:	3456 43RD ST APT C3
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1249
Country	:	US
Telephone Number	:	646-657-5653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3456 43RD ST
Second Line	:	APT C3
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1249
Country	:	US
Telephone Number	:	646-657-5653
Fax Number	:

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

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/31/2016

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