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General NPI Number Information
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NPI Number | 1770679409
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Entity Type | Individual
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Provider Name | EUNJA KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 2180 CENTER AVE STE.1
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City | FORT LEE
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State | NJ
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Zip | 07024-5860
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Country | US
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Telephone | 201-461-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 16410 NORTHERN BLVD STE 207
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City | FLUSHING
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State | NY
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Zip | 11358-2677
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Country | US
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Telephone | 201-370-7379
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA66976
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 198971-1
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License Number State | NY
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