Provider Demographics
NPI:1942368741
Name:KIM, KYUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:KYUNG
Other - Middle Name:
Other - Last Name:HU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:389 ROUTE 10 EAST
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936
Mailing Address - Country:US
Mailing Address - Phone:973-781-0800
Mailing Address - Fax:
Practice Address - Street 1:389 ROUTE 10 EAST
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936
Practice Address - Country:US
Practice Address - Phone:973-781-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005847152W00000X
NJ27OA00550300152W00000X
NJ27TO00088800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7452004Medicaid
NJ004655Medicare ID - Type Unspecified
NJ7452004Medicaid