Provider Demographics
NPI:1669651394
Name:CHONG, KI HYUN (MPT)
Entity Type:Individual
Prefix:MR
First Name:KI HYUN
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HICKORY HILL CT
Mailing Address - Street 2:07866
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4821
Mailing Address - Country:US
Mailing Address - Phone:347-638-4735
Mailing Address - Fax:
Practice Address - Street 1:280 GRAND AVE
Practice Address - Street 2:3A
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1167
Practice Address - Country:US
Practice Address - Phone:917-270-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 022569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist