1316199367 NPI number — HONGSOON KIM

Table of content: HONGSOON KIM (NPI 1316199367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316199367 NPI number — HONGSOON KIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
HONGSOON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1316199367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 GAYNOR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROCK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07452-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-445-2844
Provider Business Mailing Address Fax Number:
201-840-1074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 RARITAN AVE STE 430
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08904-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-729-1075
Provider Business Practice Location Address Fax Number:
732-342-7355
Provider Enumeration Date:
10/21/2008

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: 171100000X , with the licence number:  MZ00061700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 003767 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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