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NPI Code Detail

MEDICARE: DOO TAE KIM M.D.

MEDICARE: DOO TAE KIM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMD-034047-LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285638056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOO TAE KIM M.D.
Provider Business Mailing Address
First Line : PO BOX 18764
Second Line :
City : NEWARK
State : NJ
Zip : 07191-8764
Country : US
Telephone Number : 201-804-2800
Fax Number :
Provider Business Practice Location Address
First Line : 250 S 21ST ST
Second Line :
City : EASTON
State : PA
Zip : 18042-3851
Country : US
Telephone Number : 610-250-4303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/08/2007

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