Individual
MR. KEVIN YUDIANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
17900 LINDEN BLVD RM 219A, JAMAICA, NY 11425-0001
(718) 526-1000
Mailing address
17900 LINDEN BLVD RM 219A, JAMAICA, NY 11425-0001
(718) 526-1000
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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