Provider Demographics
NPI:1205983558
Name:KIM, YON SOOK (MD)
Entity type:Individual
Prefix:
First Name:YON
Middle Name:SOOK
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 300
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06099000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K6129OtherHEALTHNET
NJP3737086OtherOXFORD HEALTH
NJ2817587000OtherAMERIHEALTH/KEYSTONE/HMO/PPO
NJ60033821OtherHORIZON NJ HEALTH
NJ466570OtherAETNA PPO
NJ6273009Medicaid
NJ2243154OtherCIGNA
NJ60030400OtherHORIZON NJ HEALTH
NJ010078199OtherAMERICHOICE
NJ1454572OtherAETNA HMO
NJ1736174OtherUNITED HEALTHCARE
NJ6273009Medicaid
NJ575971BKRMedicare PIN