MEDICARE: DR. WUN JUNG KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35048297	OH
2	2084P0804X	Child & Adolescent Psychiatry Physician	35048297	OH
3	2084P0804X	Child & Adolescent Psychiatry Physician	25MA09416600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982690525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WUN JUNG KIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 829642
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-9642
Country	:	US
Telephone Number	:	866-470-6626
Fax Number	:	413-599-0470

Provider Business Practice Location Address
First Line	:	671 HOES LN W STE 338A
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8021
Country	:	US
Telephone Number	:	732-235-7647
Fax Number	:	732-235-4220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/23/2021

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