Provider Demographics
NPI:1952185720
Name:CUNANAN, KIM CHRISTIAN PANGILINAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KIM CHRISTIAN
Middle Name:PANGILINAN
Last Name:CUNANAN
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 METROPOLITAN AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6638
Mailing Address - Country:US
Mailing Address - Phone:929-586-8266
Mailing Address - Fax:
Practice Address - Street 1:18716 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3216
Practice Address - Country:US
Practice Address - Phone:929-586-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist