Provider Demographics
NPI:1417399874
Name:HYUN J KIM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:HYUN J KIM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-258-7702
Mailing Address - Street 1:19315C 69TH AVE
Mailing Address - Street 2:#2B
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4007
Mailing Address - Country:US
Mailing Address - Phone:646-253-7702
Mailing Address - Fax:
Practice Address - Street 1:615 SENECA AVE
Practice Address - Street 2:#1FL
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2170
Practice Address - Country:US
Practice Address - Phone:718-497-9760
Practice Address - Fax:718-197-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty