Provider Demographics
NPI:1588829352
Name:KIM, ANN DONGHYUN (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:DONGHYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONGHYUN
Other - Middle Name:ANN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:44 SYLVAN AVE.
Mailing Address - Street 2:2D
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-585-0958
Mailing Address - Fax:201-585-0902
Practice Address - Street 1:44 SYLVAN AVE
Practice Address - Street 2:2D
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2426
Practice Address - Country:US
Practice Address - Phone:201-961-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08431800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0174653Medicaid
NJ129699Medicare PIN