Healthcare Provider Details

I. General information

NPI: 1053475673
Provider Name (Legal Business Name): CHRISTI YOUNG-AH KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 RIVER ROAD 2ND FLOOR
NORTH BERGEN NJ
07047-6526
US

IV. Provider business mailing address

500 FRANK W BURR BLVD ST 560 MAILBOX #29
TEANECK NJ
07666-6804
US

V. Phone/Fax

Practice location:
  • Phone: 201-464-0008
  • Fax: 860-271-4947
Mailing address:
  • Phone: 201-510-0910
  • Fax: 201-621-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number69562
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2822966
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA12290200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: