Provider Demographics
NPI:1073854501
Name:DR JOHN KIMS MEDICAL OFFICE PC
Entity Type:Organization
Organization Name:DR JOHN KIMS MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:DOEYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-946-6923
Mailing Address - Street 1:2815 JOHN F KENNEDY BLVD
Mailing Address - Street 2:2C
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3936
Mailing Address - Country:US
Mailing Address - Phone:201-946-6923
Mailing Address - Fax:201-946-6924
Practice Address - Street 1:2815 JOHN F KENNEDY BLVD
Practice Address - Street 2:2C
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3900
Practice Address - Country:US
Practice Address - Phone:201-946-6923
Practice Address - Fax:201-946-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08080200261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty