Provider Demographics
NPI:1922423656
Name:KIM, YOOHYUN (DPT)
Entity Type:Individual
Prefix:
First Name:YOOHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 43RD ST APT C3
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1249
Mailing Address - Country:US
Mailing Address - Phone:646-657-5653
Mailing Address - Fax:
Practice Address - Street 1:3456 43RD ST
Practice Address - Street 2:APT C3
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1249
Practice Address - Country:US
Practice Address - Phone:646-657-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist