Provider Demographics
NPI:1245356971
Name:KIM, DAVID H (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:239 TAUNTON BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3471
Mailing Address - Country:US
Mailing Address - Phone:856-608-1130
Mailing Address - Fax:856-608-7630
Practice Address - Street 1:239 TAUNTON BLVD STE A2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3471
Practice Address - Country:US
Practice Address - Phone:856-608-1130
Practice Address - Fax:856-608-7630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD054441L208100000X
NJMA68025208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG24627Medicare UPIN