Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA11030700 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA11030700 | NJ |
NPI | 1144752122 |
---|---|
Provider Name | Mitchell Kim |
First Address | New Brunswick, NJ 08901-2008 |
Second Address | Eatontown, NJ 07724-1887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 11/01/2022 |