Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 22DI02301100 | NJ |
N | 1223P0300X | Periodontist | DS030373L | PA |
NPI | 1073655981 |
---|---|
Provider Name | Doshik Kim |
First Address | Medford, NJ 08055-8772 |
Second Address | Medford, NJ 08055-8772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |