Provider Demographics
NPI:1558307579
Name:KIM, SAM KWANG (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:KWANG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:228 ROSEBERRY ST
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1687
Mailing Address - Country:US
Mailing Address - Phone:908-454-4545
Mailing Address - Fax:908-454-3227
Practice Address - Street 1:228 ROSEBERRY ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1687
Practice Address - Country:US
Practice Address - Phone:908-454-4545
Practice Address - Fax:908-454-3227
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02776000208000000X
PAMD019259Y208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0392405Medicaid