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General NPI Number Information
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NPI Number | 1437041225
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Entity Type | Organization
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Legal Business Name | MJ SURGEON GROUP LLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 135 CHESTNUT RIDGE RD STE 1150
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City | MONTVALE
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State | NJ
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Zip | 07645-1152
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Country | US
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Telephone | 862-205-3056
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Fax |
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Provider Business Mailing Address
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Address Line | 625 W 57TH ST APT 2406
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City | NEW YORK
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State | NY
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Zip | 10019-2687
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Country | US
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Telephone | 646-455-8286
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Fax |
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Authorized Official
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Title or Position | ORAL & MAXILLOFACIAL SURGEON
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Name | DR. JAY KIM
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Credential | DMD
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Telephone | 646-455-8286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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