Provider Demographics
NPI:1831137926
Name:KO, KYONGHYUN (PT)
Entity Type:Individual
Prefix:
First Name:KYONGHYUN
Middle Name:
Last Name:KO
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 1:3518 150TH PL FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4922
Mailing Address - Country:US
Mailing Address - Phone:718-445-4370
Mailing Address - Fax:
Practice Address - Street 1:3518 150TH PL FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4922
Practice Address - Country:US
Practice Address - Phone:718-445-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07830Medicare PIN
NY06089HMedicare PIN