Provider Demographics
NPI:1093723314
Name:KIM, CHEE GAP (MD)
Entity Type:Individual
Prefix:
First Name:CHEE
Middle Name:GAP
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 GRAND AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4934
Mailing Address - Country:US
Mailing Address - Phone:201-541-1111
Mailing Address - Fax:201-541-0777
Practice Address - Street 1:535 GRAND AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-541-1111
Practice Address - Fax:201-541-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51283225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE22072Medicare UPIN
NJKI475439Medicare ID - Type Unspecified