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General NPI Number Information
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NPI Number | 1528710217
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Entity Type | Organization
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Legal Business Name | SKNJ PODIATRY PC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 301 GLEN DR
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1316
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Country | US
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Telephone | 347-467-0266
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Fax |
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Provider Business Mailing Address
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Address Line | 199 STATE ST APT 10B
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City | BROOKLYN
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State | NY
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Zip | 11201-8707
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Country | US
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Telephone | 347-467-0266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANGHO KIM
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Credential | DPM
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Telephone | 347-467-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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