Provider Demographics
NPI:1043233588
Name:KIM, JIMMY (JAMES KIM)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:JAMES KIM
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JAMES KIM
Mailing Address - Street 1:300 WINSTON DR APT 217
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3210
Mailing Address - Country:US
Mailing Address - Phone:201-693-1531
Mailing Address - Fax:201-969-2752
Practice Address - Street 1:300 WINSTON DR APT 217
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3210
Practice Address - Country:US
Practice Address - Phone:201-693-1531
Practice Address - Fax:201-969-2752
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00840500204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine