Provider Demographics
NPI:1598053530
Name:KIM, SEONGSIK (PT)
Entity Type:Individual
Prefix:MR
First Name:SEONGSIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18902 64TH AVE
Mailing Address - Street 2:#9B
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3853
Mailing Address - Country:US
Mailing Address - Phone:347-247-7462
Mailing Address - Fax:
Practice Address - Street 1:4214 162ND ST
Practice Address - Street 2:1FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4125
Practice Address - Country:US
Practice Address - Phone:718-939-7999
Practice Address - Fax:718-939-7799
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist