MEDICARE: DR. EUNJA 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	208000000X	Pediatrics Physician	MA66976	NJ
2	208000000X	Pediatrics Physician	198971-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8H6982	OTHER	NJ	EMPIRE BCBS
2	P961741	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1770679409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUNJA KIM M.D.

Provider Business Mailing Address
First Line	:	16410 NORTHERN BLVD
Second Line	:	STE 207
City	:	FLUSHING
State	:	NY
Zip	:	11358-2677
Country	:	US
Telephone Number	:	201-370-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 CENTER AVE
Second Line	:	STE.1
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5860
Country	:	US
Telephone Number	:	201-461-6677
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/25/2014

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Directions to “ DR. EUNJA KIM M.D.” Practice Location

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