Provider Demographics
NPI:1548580145
Name:SUN KI CENTER INC
Entity Type:Organization
Organization Name:SUN KI CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KISUK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-661-4130
Mailing Address - Street 1:14351 ROOSEVELT AVE.
Mailing Address - Street 2:SUITE 1 F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-661-4130
Mailing Address - Fax:718-661-4132
Practice Address - Street 1:14351 ROOSEVELT AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6155
Practice Address - Country:US
Practice Address - Phone:718-661-4130
Practice Address - Fax:718-661-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03103959Medicaid