Provider Demographics
NPI:1295015063
Name:KIM, MI SUK
Entity Type:Individual
Prefix:
First Name:MI SUK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HORIZON RD
Mailing Address - Street 2:APT # 2504
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6652
Mailing Address - Country:US
Mailing Address - Phone:917-582-6187
Mailing Address - Fax:
Practice Address - Street 1:464 HUDSON TER STE 204
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2917
Practice Address - Country:US
Practice Address - Phone:917-582-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00051900171100000X
NJ40QA01625000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist