Provider Demographics
NPI:1174721815
Name:KIM, JUNESUG PETER
Entity type:Individual
Prefix:
First Name:JUNESUG
Middle Name:PETER
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 THOMAS STREET, #22
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5M 5N8
Mailing Address - Country:CA
Mailing Address - Phone:905-285-0213
Mailing Address - Fax:
Practice Address - Street 1:700 LAWRENCE AVE WEST, SUITE 362
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M6A 3B4
Practice Address - Country:CA
Practice Address - Phone:416-785-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist