Healthcare Provider Details

I. General information

NPI: 1699688812
Provider Name (Legal Business Name): HYUNJU KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-08 ROUTE 208 STE 16
FAIR LAWN NJ
07410-2609
US

IV. Provider business mailing address

301 NELSON CT
EDGEWATER NJ
07020-1632
US

V. Phone/Fax

Practice location:
  • Phone: 201-956-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07556400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: