Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 25MA07795000 | NJ |
N | 207RC0000X | Internist - Cardiovascular Disease | 248070 | NY |
NPI | 1518166420 |
---|---|
Provider Name | Bernard Haksoo Kim |
First Address | Hackensack, NJ 07601-1997 |
Second Address | Hackensack, NJ 07601-1997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02961053 | (05) | NY |