Provider Demographics
NPI:1972878932
Name:KIM, JISUN ESTHER (PT)
Entity type:Individual
Prefix:MS
First Name:JISUN
Middle Name:ESTHER
Last Name:KIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JISUN
Other - Middle Name:ESTHER
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4955 S ALMA SCHOOL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:480-812-1800
Mailing Address - Fax:480-812-1839
Practice Address - Street 1:4955 S ALMA SCHOOL RD STE 10
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-812-1800
Practice Address - Fax:480-812-1839
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025610-1OtherUNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT OFF ICE OF PROFESSIONS