Individual
MR. DAEGYUN KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, LAC
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
25MZ00040500
NJ
225100000X
Physical Therapist
017470
NY
225100000X
Physical Therapist
Primary
40QA01140100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02646413
—
NY
Enumeration date
07/06/2006
Last updated
03/05/2021
Update your record
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