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General NPI Number Information
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NPI Number | 1619150448
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Entity Type | Individual
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Provider Name | EUNYOUNG RACHEL KIM P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2007
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 1 RWJ PLACE ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901
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Country | US
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Telephone | 732-390-0040
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Fax | 732-390-1856
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Provider Business Mailing Address
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Address Line | 579A CRANBURY RD.
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-390-0040
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Fax | 732-390-1856
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 012293
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00198700
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License Number State | NJ
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