Provider Demographics
NPI:1366157547
Name:KIM, BRIAN ALEXANDER (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 WILLETS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3544
Mailing Address - Country:US
Mailing Address - Phone:646-915-4558
Mailing Address - Fax:
Practice Address - Street 1:14703 WILLETS POINT BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3544
Practice Address - Country:US
Practice Address - Phone:646-915-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist