Provider Demographics
NPI:1407157936
Name:KIM, CHRISTINE SUJUNG (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SUJUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SYLVAN AVE STE 301A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2531
Mailing Address - Country:US
Mailing Address - Phone:201-655-8483
Mailing Address - Fax:201-461-2503
Practice Address - Street 1:140 SYLVAN AVE STE 301A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2531
Practice Address - Country:US
Practice Address - Phone:201-655-8483
Practice Address - Fax:201-461-2503
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2019-12-21
Deactivation Date:2019-11-18
Deactivation Code:
Reactivation Date:2019-11-27
Provider Licenses
StateLicense IDTaxonomies
86101311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered