Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 25MA04647100 | NJ |
NPI | 1417900135 |
---|---|
Provider Name | Dr. Yukiko Kimura |
First Address | Hackensack, NJ 07601-1914 |
Second Address | Hackensack, NJ 07601-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0751502 | (05) | NJ |
F10652 | (02) | NJ |