Provider Demographics
NPI:1760435101
Name:KIM, OKJA K (MD)
Entity Type:Individual
Prefix:DR
First Name:OKJA
Middle Name:K
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 1:239 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2292
Mailing Address - Country:US
Mailing Address - Phone:732-635-1577
Mailing Address - Fax:732-635-1576
Practice Address - Street 1:239 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2292
Practice Address - Country:US
Practice Address - Phone:732-635-1577
Practice Address - Fax:732-635-1576
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038336208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ604083Medicare PIN
NJE44152Medicare UPIN