Provider Demographics
NPI:1982579322
Name:KIM, YOUNG JIN (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:JIN
Last Name:KIM
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 US HIGHWAY 22 STE 200V
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2957
Mailing Address - Country:US
Mailing Address - Phone:201-655-3300
Mailing Address - Fax:
Practice Address - Street 1:810 ABBOTT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4116
Practice Address - Country:US
Practice Address - Phone:201-655-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02375000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty