Provider Demographics
NPI:1548213796
Name:KIM, STEVE S (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5005
Mailing Address - Country:US
Mailing Address - Phone:201-461-6200
Mailing Address - Fax:201-461-7204
Practice Address - Street 1:2200 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5005
Practice Address - Country:US
Practice Address - Phone:201-461-6200
Practice Address - Fax:201-461-7204
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07884800207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074799Medicaid
NJ699887OtherMEDICARE GROUP
NJ091480C3ZMedicare ID - Type Unspecified
NJ0074799Medicaid