Provider Demographics
NPI:1467442384
Name:KIM, JOHN YOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:YOHAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5187
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 211
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:856-576-5742
Practice Address - Fax:856-519-5457
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255713207K00000X, 207R00000X
NJ25MA09095500207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3410623OtherCIGNA
NJ3881423000OtherAMERIHEALTH
NJ3410623OtherCIGNA