Individual
JUNG H KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
309A BROAD AVE, PALISADES PARK, NJ 07650-1620
(201) 242-9300
Mailing address
2175 HUDSON TER APT 7I, FORT LEE, NJ 07024-7715
(201) 676-0029
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
056054
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
22DI02504500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034481918
—
NY
01
—
P77908
NY STATE TEACHING PERMIT NO
NY
Enumeration date
06/15/2011
Last updated
11/15/2012
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