Provider Demographics
NPI:1326522145
Name:KIM, SEUNG EUN
Entity Type:Individual
Prefix:
First Name:SEUNG EUN
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 1:1424 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2116
Mailing Address - Country:US
Mailing Address - Phone:201-482-0801
Mailing Address - Fax:201-331-1444
Practice Address - Street 1:1424 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2116
Practice Address - Country:US
Practice Address - Phone:201-482-0801
Practice Address - Fax:201-331-1444
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03966600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03966600OtherNJ PHARMACIST LICENSE