Healthcare Provider Details

I. General information

NPI: 1922516871
Provider Name (Legal Business Name): MIN-MIN LI-AH-KIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 ROUTE 517
HACKETTSTOWN NJ
07840-2708
US

IV. Provider business mailing address

1575 ROUTE 517
HACKETTSTOWN NJ
07840-2708
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-0107
  • Fax: 908-850-9160
Mailing address:
  • Phone: 908-852-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00792400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: