Organization
JACKSON FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIAH KIM DO (OWNER)
(732) 683-0010
Entity
Organization
Contact information
Practice address
80 SCENIC DR, SUITE 6, FREEHOLD, NJ 07728-5210
(732) 683-0010
Mailing address
80 SCENIC DR, SUITE 6, FREEHOLD, NJ 07728-5210
(732) 683-0010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB05981900
NJ
Other
Enumeration date
12/19/2008
Last updated
06/21/2018
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