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NPI Code Detail

MEDICARE: KATHLYN KIM

MEDICARE: KATHLYN KIM
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
1174400000XSpecialist25MA06066900NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1183893OTHERNJEMPIRE BC/BS (RAMSEY)
2183891OTHERNJEMPIRE BC/BS (MIDLAND PK)
3872550OTHERNJAETNA HMO #
4160045813OTHERNJRAILROAD MDCR #
54506818OTHERNJAETNA PPO #
6BP357OTHERNJOXFORD #

General Provider Information

NPI Number : 1730174715
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLYN KIM
Provider Business Mailing Address
First Line : 581 N FRANKLIN TPKE
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1139
Country : US
Telephone Number : 201-236-2100
Fax Number : 201-236-5081
Provider Business Practice Location Address
First Line : 581 N FRANKLIN TPKE
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1139
Country : US
Telephone Number : 201-236-2100
Fax Number : 201-236-5081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 04/08/2009

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Directions to “ KATHLYN KIM ” Practice Location

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