Provider Demographics
NPI:1174061907
Name:JEONG HO KIM PHYSICAL THERAPY, P.C
Entity type:Organization
Organization Name:JEONG HO KIM PHYSICAL THERAPY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-233-4979
Mailing Address - Street 1:185 CANAL ST # 501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4537
Mailing Address - Country:US
Mailing Address - Phone:646-666-0322
Mailing Address - Fax:646-666-0904
Practice Address - Street 1:185 CANAL ST # 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4537
Practice Address - Country:US
Practice Address - Phone:646-666-0322
Practice Address - Fax:646-666-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033030261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy