Healthcare Provider Details

I. General information

NPI: 1407769102
Provider Name (Legal Business Name): SOOHYUN KIM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

2207 STATION PL
CHERRY HILL NJ
08003-2337
US

V. Phone/Fax

Practice location:
  • Phone: 855-632-6737
  • Fax:
Mailing address:
  • Phone: 201-290-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number28RI04505800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: