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General NPI Number Information
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NPI Number | 1083116156
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Entity Type | Individual
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Provider Name | MIN JUNG KIM
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 220 MADISON AVE STE A
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City | NEW YORK
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State | NY
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Zip | 10016-3422
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Country | US
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Telephone | 212-880-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 900 AVE AT PORT IMPERIAL BLVD APT 709
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City | WEEHAWKEN
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State | NJ
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Zip | 07086-6106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 061567
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02791400
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License Number State | NJ
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