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General NPI Number Information
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NPI Number | 1316856719
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Entity Type | Individual
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Provider Name | JAEWON KIM
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Gender | Male
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 225 SUMMIT AVE
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City | MONTVALE
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State | NJ
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Zip | 07645-1523
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Country | US
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Telephone | 201-472-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 56 BROWNSTONE WAY APT 414
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1224
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Country | US
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Telephone | 201-969-5557
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI04110500
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License Number State | NJ
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