MEDICARE: DR. JOHN YOHAN 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
1	207K00000X	Allergy & Immunology Physician	255713	NY
2	207R00000X	Internal Medicine Physician	255713	NY
3	207K00000X	Allergy & Immunology Physician	25MA09095500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3410623	OTHER	NJ	CIGNA
2	3881423000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1467442384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN YOHAN KIM M.D.

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5187
Country	:	US
Telephone Number	:	914-333-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 211
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	856-576-5742
Fax Number	:	856-519-5457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2005
Last Update Date	:	02/20/2025

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Directions to “ DR. JOHN YOHAN KIM M.D.” Practice Location

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