Healthcare Provider Details

I. General information

NPI: 1457580177
Provider Name (Legal Business Name): CHRISTIAN C KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 LEMOINE AVE STE 203
FORT LEE NJ
07024-5636
US

IV. Provider business mailing address

1608 LEMOINE AVE STE 203
FORT LEE NJ
07024-5636
US

V. Phone/Fax

Practice location:
  • Phone: 201-944-8400
  • Fax: 201-944-8411
Mailing address:
  • Phone: 201-944-8400
  • Fax: 201-944-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA08635500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number241184
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: