1215970967 NPI number — HAZEL H KIM M.D.

Table of content: HAZEL H KIM M.D. (NPI 1215970967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215970967 NPI number — HAZEL H KIM M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
HAE
Provider Other Middle Name:
SOOK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215970967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 JAMES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-321-7680
Provider Business Mailing Address Fax Number:
732-321-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-321-7680
Provider Business Practice Location Address Fax Number:
732-321-7008
Provider Enumeration Date:
06/13/2006

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: 207ZP0102X , with the licence number:  25MA03785800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZH0000X , with the licence number: 25MA03785800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2010500 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".