1437175916 NPI number — ROSE KIM MD

Table of content: ROSE KIM MD (NPI 1437175916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437175916 NPI number — ROSE KIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
ROSE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437175916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL ST # 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLZ
Provider Second Line Business Practice Location Address:
SUITE 513 (INFECTIOUS DISEASE)
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-963-3715
Provider Business Practice Location Address Fax Number:
856-635-1052
Provider Enumeration Date:
07/15/2006

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: 207RI0200X , with the licence number:  MA080680 , 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: 01077778400 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1297027 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0109614 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60025900 . This is a "HIRIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6106 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43500 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8897387 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3722698 . This is a "OXFORD HELATH PAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2739748000 . This is a "AMERIHEALTH HMO, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2633237 . This is a "UNITED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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