Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 25MA07697000 | NJ |
N | 207W00000X | Ophthalmologist | 202911 | NY |
NPI | 1659404366 |
---|---|
Provider Name | Dr. Elizabeth Eon Kim |
First Address | Fort Lee, NJ 07024-1621 |
Second Address | Bronx, NY 10468-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G78153 | (02) | NY |