Provider Demographics
NPI:1538369285
Name:KIM, HAN NA (PT)
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:NA
Last Name:KIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-09 108TH ST.
Mailing Address - Street 2:SUITE LL
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-205-2230
Mailing Address - Fax:718-205-2245
Practice Address - Street 1:41-09 108TH ST.
Practice Address - Street 2:SUITE LL
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-205-2230
Practice Address - Fax:718-205-2245
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08327HMedicare PIN