Provider Demographics
NPI:1497155691
Name:JONG H KIM,MD'S PAIN & REHAB CENTER PC
Entity Type:Organization
Organization Name:JONG H KIM,MD'S PAIN & REHAB CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-346-4347
Mailing Address - Street 1:24 CARILLON CIR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2600
Mailing Address - Country:US
Mailing Address - Phone:201-233-4626
Mailing Address - Fax:
Practice Address - Street 1:158 LINWOOD PLZ
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3761
Practice Address - Country:US
Practice Address - Phone:201-346-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09332600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty