Provider Demographics
NPI:1609377050
Name:KIM, GUNPYO (DPT)
Entity Type:Individual
Prefix:DR
First Name:GUNPYO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E BROADWAY
Mailing Address - Street 2:APT 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7184
Mailing Address - Country:US
Mailing Address - Phone:646-869-1271
Mailing Address - Fax:
Practice Address - Street 1:27 E BROADWAY APT 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7184
Practice Address - Country:US
Practice Address - Phone:646-869-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033724-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist