Provider Demographics
NPI:1144408451
Name:KIM, HYUNG (DPT, MSOT)
Entity Type:Individual
Prefix:DR
First Name:HYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1655
Mailing Address - Country:US
Mailing Address - Phone:201-566-3554
Mailing Address - Fax:201-941-7995
Practice Address - Street 1:1038 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1655
Practice Address - Country:US
Practice Address - Phone:201-566-3554
Practice Address - Fax:201-941-7995
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01219600225100000X
NJ46TR00483100225X00000X
NJ150985171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist