Provider Demographics
NPI:1730314972
Name:JU, TASHIL KIM (MD)
Entity Type:Individual
Prefix:
First Name:TASHIL
Middle Name:KIM
Last Name:JU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:70 GLEN RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1802
Mailing Address - Country:US
Mailing Address - Phone:312-498-7996
Mailing Address - Fax:201-847-0059
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 16
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1439
Practice Address - Country:US
Practice Address - Phone:201-847-9320
Practice Address - Fax:201-847-0059
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2015-12-08
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Provider Licenses
StateLicense IDTaxonomies
NJMA089718207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ224543DMFMedicare UPIN