Provider Demographics
NPI:1225105414
Name:KIM, STEVE YUN (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:YUN
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 1:2185 LEMOINE AVE
Mailing Address - Street 2:UNIT 1P
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6036
Mailing Address - Country:US
Mailing Address - Phone:201-569-9130
Mailing Address - Fax:201-569-9131
Practice Address - Street 1:2185 LEMOINE AVE
Practice Address - Street 2:UNIT 1P
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6036
Practice Address - Country:US
Practice Address - Phone:201-569-9130
Practice Address - Fax:201-569-9131
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069506207Y00000X
NY214572207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01979804Medicaid
NJ8015805Medicaid
029463Medicare ID - Type Unspecified
NJ8015805Medicaid