1073582805 NPI number — DANIEL Y. KIM, M.D., P.A.

Table of content: (NPI 1073582805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073582805 NPI number — DANIEL Y. KIM, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL Y. KIM, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1073582805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 BERGEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALISADES PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07650-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-461-3970
Provider Business Mailing Address Fax Number:
201-242-9061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 BERGEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALISADES PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07650-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-461-3970
Provider Business Practice Location Address Fax Number:
201-242-9061
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
LENA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
201-461-3970

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MA65006 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1106389 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 160591 . This is a "NEW ENGLAND ONE HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2033258 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 976044 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 180036662 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1537021 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P672617 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 976044 . This is a "EMPIREBCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK4450 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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