1730174715 NPI number — KATHLYN KIM

Table of content: KATHLYN KIM (NPI 1730174715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730174715 NPI number — KATHLYN KIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
KATHLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1730174715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
581 N FRANKLIN TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAMSEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07446-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-236-2100
Provider Business Mailing Address Fax Number:
201-236-5081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
581 N FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07446-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-236-2100
Provider Business Practice Location Address Fax Number:
201-236-5081
Provider Enumeration Date:
09/15/2005

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: 174400000X , with the licence number:  25MA06066900 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183893 . This is a "EMPIRE BC/BS (RAMSEY)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 183891 . This is a "EMPIRE BC/BS (MIDLAND PK)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 872550 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 160045813 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4506818 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BP357 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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