Provider Demographics
NPI:1962686824
Name:KIM, KIMBERLY JU (MD, MPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JU
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 C PROSPECT HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095
Mailing Address - Country:US
Mailing Address - Phone:860-285-8251
Mailing Address - Fax:860-687-1774
Practice Address - Street 1:820 C PROSPECT HILL ROAD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-285-8251
Practice Address - Fax:860-687-1774
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0468842080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine