Provider Demographics
NPI:1235550716
Name:ANN KIM MD PC
Entity Type:Organization
Organization Name:ANN KIM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-961-2808
Mailing Address - Street 1:132 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2330
Mailing Address - Country:US
Mailing Address - Phone:201-585-0957
Mailing Address - Fax:201-585-0944
Practice Address - Street 1:44 SYLVAN AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2426
Practice Address - Country:US
Practice Address - Phone:201-585-0957
Practice Address - Fax:201-585-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0174653Medicaid
NJ0174653Medicaid