Provider Demographics
NPI:1598841942
Name:KIM, YOONJOO (MD)
Entity Type:Individual
Prefix:DR
First Name:YOONJOO
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BROAD AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1569
Mailing Address - Country:US
Mailing Address - Phone:201-346-0999
Mailing Address - Fax:201-346-0118
Practice Address - Street 1:232 BROAD AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1569
Practice Address - Country:US
Practice Address - Phone:201-346-0999
Practice Address - Fax:201-346-0118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05730500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000744678Medicare ID - Type Unspecified
NJE29315Medicare UPIN