Provider Demographics
NPI:1457580177
Name:KIM, CHRISTIAN C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 LEMOINE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5636
Mailing Address - Country:US
Mailing Address - Phone:201-580-1145
Mailing Address - Fax:201-944-9411
Practice Address - Street 1:1608 LEMOINE AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5636
Practice Address - Country:US
Practice Address - Phone:201-580-1145
Practice Address - Fax:201-944-8411
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241184208M00000X
NJ25MA08635500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0524263Medicaid