Provider Demographics
NPI:1700830734
Name:KIM, YOUNG BOK (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:BOK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:444 BLACK OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6507
Mailing Address - Country:US
Mailing Address - Phone:973-696-8858
Mailing Address - Fax:973-696-6725
Practice Address - Street 1:444 BLACK OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6507
Practice Address - Country:US
Practice Address - Phone:973-696-8858
Practice Address - Fax:973-696-6725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA03082500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454654Medicare ID - Type Unspecified
NJD96822Medicare UPIN