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

Individual provider Recreation Therapist · NPI 1720790793

Mr. Kevin Yudianto, CTRS is a Recreation Therapist in Jamaica, New York. Practices as a sole proprietor. Registered with an NPI since 2022.

In the registry since
2022
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Practice location Address checks out

17900 Linden Blvd Rm 219A
Jamaica, NY 11425-0001
Phone: (718) 526-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Recreation Therapist (primary) Taxonomy 225800000X

Record details

NPI number1720790793
Entity typeIndividual (Type 1)
GenderMale
Credentials CTRS
Sole proprietorYes
NPI enumeratedDecember 21, 2022
Last updated in NPPESDecember 21, 2022
Certification dateDecember 21, 2022

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