Provider Demographics
NPI:1538161377
Name:JIN P KIM MD
Entity type:Organization
Organization Name:JIN P KIM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-935-2577
Mailing Address - Street 1:330 WOODSTOWN RD
Mailing Address - Street 2:MEDICAL ARTS BLDG 2
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079
Mailing Address - Country:US
Mailing Address - Phone:856-935-2577
Mailing Address - Fax:856-935-0726
Practice Address - Street 1:330 WOODSTOWN RD
Practice Address - Street 2:MEDICAL ARTS BLDG 2
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079
Practice Address - Country:US
Practice Address - Phone:856-935-2577
Practice Address - Fax:856-935-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02960300208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3039609Medicaid
NJ4090057OtherAETNA/US HEALTHCARE
NJ168327Medicare PIN
NJ4090057OtherAETNA/US HEALTHCARE