Provider Demographics
NPI:1811201783
Name:KIM, JOON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2350
Mailing Address - Country:US
Mailing Address - Phone:201-543-8844
Mailing Address - Fax:
Practice Address - Street 1:4520 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4900
Practice Address - Country:US
Practice Address - Phone:917-388-3129
Practice Address - Fax:917-388-3184
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03335600183500000X
NY063796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist