Provider Demographics
NPI:1487940730
Name:YOUNG MAN KIM PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:YOUNG MAN KIM PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-353-3988
Mailing Address - Street 1:16332 NORTHERN BLVD
Mailing Address - Street 2:2D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2676
Mailing Address - Country:US
Mailing Address - Phone:718-353-3988
Mailing Address - Fax:718-353-9424
Practice Address - Street 1:16332 NORTHERN BLVD
Practice Address - Street 2:2D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2676
Practice Address - Country:US
Practice Address - Phone:718-353-3988
Practice Address - Fax:718-353-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017611261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP66781Medicare UPIN