1851441208 NPI number — THOMAS J KIM M.D.

Table of content: THOMAS J KIM M.D. (NPI 1851441208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851441208 NPI number — THOMAS J KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851441208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 ALLEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASKING RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07920-2976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-604-7800
Provider Business Mailing Address Fax Number:
973-290-8370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 W OLYMPIC BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90064-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-293-8841
Provider Business Practice Location Address Fax Number:
424-293-8842
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  25MA08326900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VE0102X , with the licence number: G63902 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)