Provider Demographics
NPI:1922042795
Name:DOHYUNG KIM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DOHYUNG KIM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOHYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-888-1641
Mailing Address - Street 1:15301 NORTHERN BLVD.
Mailing Address - Street 2:STE. 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5038
Mailing Address - Country:US
Mailing Address - Phone:718-888-1641
Mailing Address - Fax:718-888-2514
Practice Address - Street 1:15301 NORTHERN BLVD.
Practice Address - Street 2:STE. 2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5038
Practice Address - Country:US
Practice Address - Phone:718-888-1641
Practice Address - Fax:718-888-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590958Medicaid
NY02590958Medicaid