Active NPI
Edward Tae Kim
- General Practice Physician
- Runnemede, NJ
National Provider Identifier
1457567836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 11227
- Practice address
- 658 N Black Horse PK
Runnemede, NJ 08078 - Phone
- (856) 939-3405
- Fax
- (856) 939-0104
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 11227 | NJ | Primary |
Addresses
Primary practice location
658 N Black Horse PK
Runnemede, NJ 08078
Mailing address
658 N Black Horse PK
Runnemede, NJ 08078
Phone (856) 939-3405
Other names 1
- Edward Tae Kim
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11227 | NJ | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457567836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "658 N BLACK HORSE PK",
"city": "RUNNEMEDE",
"state": "NJ",
"postal_code": "08078",
"telephone_number": "856-939-3405",
"fax_number": "856-939-0104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "658 N BLACK HORSE PK",
"city": "RUNNEMEDE",
"state": "NJ",
"postal_code": "08078",
"telephone_number": "856-939-3405",
"fax_number": "856-939-0104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EDWARD",
"middle_name": "TAE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NJ",
"license": "11227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EDWARD",
"last_name": "KIM",
"middle_name": "TAE",
"credential": "DMD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Runnemede, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.