Provider Demographics
NPI:1659331221
Name:KIM, HAROLD J (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:J
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 1:62 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2676
Mailing Address - Country:US
Mailing Address - Phone:973-746-8585
Mailing Address - Fax:973-746-0088
Practice Address - Street 1:62 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2676
Practice Address - Country:US
Practice Address - Phone:973-746-8585
Practice Address - Fax:973-746-0088
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07472300207R00000X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118055B82OtherMEDICARE ID-TYPE UNSPECIFIED
NYW22431OtherMEDICARE ID TYPE UNSPECIFIED
NY643P022431OtherMEDICARE ID TYPE UNSPECIFIED
NYHK0643P020OtherMEDICARE ID TYPE UNSPECIFIED
I33828Medicare UPIN
NJ64301Medicare PIN