Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jeffrey Jisung Kim, PTDPT

Individual provider Physical Therapist · NPI 1073197984

Jeffrey Jisung Kim, PTDPT is a Physical Therapist in Private Practice in Bryan, Texas. Qualified in 2020, 6 years ago. Practices with Advance Therapy, PC, a 14-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
6
Licensed in
TX
In the registry since
2021
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Practice location Address checks out

3700 Cross Park Dr
Bryan, TX 77802-4137
Phone: (979) 774-9958
Fax: (979) 774-9978
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1345176 (TX)

Record details

NPI number1073197984
Entity typeIndividual (Type 1)
GenderMale
Credentials PTDPT
Sole proprietorNo
NPI enumeratedMay 6, 2021
Last updated in NPPESMay 7, 2021
Certification dateMay 7, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Advance Therapy, Pc — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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