Provider Demographics
NPI:1740903038
Name:KIM'S NEW STAR
Entity type:Organization
Organization Name:KIM'S NEW STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-500-2090
Mailing Address - Street 1:654 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1270
Mailing Address - Country:US
Mailing Address - Phone:385-500-2090
Mailing Address - Fax:
Practice Address - Street 1:654 E 3300 S
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84106-1270
Practice Address - Country:US
Practice Address - Phone:385-500-2090
Practice Address - Fax:385-415-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility