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General NPI Number Information
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NPI Number | 1659190502
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE PHYSICIANS GROUP, P.C.
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1 GATEWAY CTR
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City | NEWARK
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State | NJ
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Zip | 07102-5310
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Country | US
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Telephone | 617-505-1520
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Fax |
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Provider Business Mailing Address
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Address Line | 109 STATE ST STE 5
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City | BOSTON
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State | MA
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Zip | 02109-2906
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Country | US
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Telephone | 617-505-1520
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAM HO KIM
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Credential |
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Telephone | 714-417-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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