Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 290542 | NY |
NPI | 1760640478 |
---|---|
Provider Name | Dr. Jongho Kim |
First Address | Tenafly, NJ 07670-1938 |
Second Address | New York, NY 10032-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
860279748 | UNITEDHEALTHCARE (01) | NY |