Active NPI
Soon Young Kim, DPT
- Pediatric Physical Therapist
- Brooklyn, NY
National Provider Identifier
1710121074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 014640-1
- Practice address
- 1311 55TH St
Brooklyn, NY 11219-4202 - Phone
- (718) 851-6100
- NPI assigned
- Apr 29, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 014640-1 | NY | Primary |
Addresses
Primary practice location
1311 55TH St
Brooklyn, NY 11219-4202
Mailing address
17 Beechwood Ave
Metuchen, NJ 08840-2106
Phone (732) 516-1927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041640 | NY | MD | Pharmacist |
| 014640-1 | NY | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240963200000",
"number": "1710121074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 BEECHWOOD AVE",
"city": "METUCHEN",
"state": "NJ",
"postal_code": "088402106",
"telephone_number": "732-516-1927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 55TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112194202",
"telephone_number": "718-851-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOON",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-29",
"last_updated": "2009-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "014640-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.