Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 22DJ02489100 | NJ |
N | 1223P0300X | Periodontist | 50056960 | NY |
NPI | 1134555667 |
---|---|
Provider Name | Dr. Min H Kim |
First Address | Somerville, NJ 08876 |
Second Address | Somerville, NJ 08876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 27/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22DJ02489100 | DENTAL LICENSE (01) | NJ |