Active NPI
Jung Tae Kim, P.T.
- Physical Therapist
- Linden, NJ
National Provider Identifier
1821127192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA00148400
- Practice address
- 210 West St. Georges Ave
Linden, NJ 07036 - Phone
- (908) 587-1624
- Fax
- (908) 587-1628
- NPI assigned
- Mar 5, 2007
- Reactivated
- Mar 1, 2017
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA00148400 | NJ | Primary |
Addresses
Primary practice location
210 West St. Georges Ave
Linden, NJ 07036
Mailing address
66 Overbrook Ave
Edison, NJ 08817-5528
Phone (732) 572-7380
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 |
|---|---|---|---|
| 40QA00148400 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488326400000",
"number": "1821127192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 OVERBROOK AVE",
"city": "EDISON",
"state": "NJ",
"postal_code": "088175528",
"telephone_number": "732-572-7380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 WEST ST. GEORGES AVE",
"city": "LINDEN",
"state": "NJ",
"postal_code": "07036",
"telephone_number": "908-587-1624",
"fax_number": "908-587-1628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JUNG",
"middle_name": "TAE",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2017-03-01",
"deactivation_date": "2017-02-27",
"reactivation_date": "2017-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA00148400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Linden, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.