Active NPI
Joh W Kim, MD
- Pediatrics Physician
- Bridgeton, NJ
National Provider Identifier
1932292109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA02856900
- Practice address
- 10 Magnolia Avenue
BLDG B Suite I
Bridgeton, NJ 08302 - Phone
- (856) 451-4140
- Fax
- (856) 451-3657
- NPI assigned
- Oct 2, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA02856900 | NJ | Primary |
Addresses
Primary practice location
10 Magnolia Avenue
BLDG B Suite I
Bridgeton, NJ 08302
Mailing address
10 Magnolia Avenue
BDG B Suite I
Bridgeton, NJ 08302
Phone (856) 451-4140
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA02856900 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932292109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MAGNOLIA AVENUE",
"address_2": "BDG B SUITE I",
"city": "BRIDGETON",
"state": "NJ",
"postal_code": "08302",
"telephone_number": "856-451-4140",
"fax_number": "856-451-3657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MAGNOLIA AVENUE",
"address_2": "BLDG B SUITE I",
"city": "BRIDGETON",
"state": "NJ",
"postal_code": "08302",
"telephone_number": "856-451-4140",
"fax_number": "856-451-3657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JOH",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA02856900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, 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.