Healthcare Provider Details

I. General information

NPI: 1538161377
Provider Name (Legal Business Name): JIN P KIM MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WOODSTOWN RD MEDICAL ARTS BLDG 2
SALEM NJ
08079
US

IV. Provider business mailing address

330 WOODSTOWN RD MEDICAL ARTS BLDG 2
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-2577
  • Fax: 856-935-0726
Mailing address:
  • Phone: 856-935-2577
  • Fax: 856-935-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA02960300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA02960300
License Number StateNJ

VIII. Authorized Official

Name: LINDA S BOOTH
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-935-2577