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

Ki Sum Fan

Individual provider Physical Therapist · NPI 1467266122

Ki Sum Fan is a Physical Therapist in Private Practice in Whitestone, New York. Qualified in 2024, 2 years ago. Practices with Sports Physical Therapy Occupational Therapy and Rehabilitation Servic, a 529-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2025
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Practice location Address checks out

15253 10th Ave
Whitestone, NY 11357-1252
Phone: (718) 587-0850
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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 053617 (NY)

Record details

NPI number1467266122
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 4, 2025
Last updated in NPPESFebruary 4, 2025
Certification dateFebruary 4, 2025
Mailing address972 Brush Hollow Rd Fl 4, Westbury, NY 11590-1740

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Sports Physical Therapy Occupational Therapy And Rehabilitation Servic — 529 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Whitestone