Provider Demographics
NPI:1891011854
Name:JOHN KIM MD MED & GERIATRICS, LLC
Entity Type:Organization
Organization Name:JOHN KIM MD MED & GERIATRICS, LLC
Other - Org Name:JOHN KIM ,MD INTERNAL MEDICINE & GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-7300
Mailing Address - Street 1:158 LINWOOD PLAZA #324-325
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-944-7300
Mailing Address - Fax:201-944-7311
Practice Address - Street 1:158 LINWOOD PLAZA #324-325
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-944-7300
Practice Address - Fax:201-944-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RG0300X
NJ25MA06862000207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7954604Medicaid
NJ7954604Medicaid
NJ0227700Medicare PIN