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General NPI Number Information
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NPI Number | 1568704054
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Entity Type | Individual
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Provider Name | MINA JUNG KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 140 PARK AVE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1049
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Country | US
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Telephone | 973-404-9700
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Fax | 908-673-7336
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Provider Business Mailing Address
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Address Line | 622 W 168TH ST PH5-133
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-305-3226
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Fax | 212-305-3204
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA10050300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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