Provider Demographics
NPI:1053568873
Name:KIM, BRIAN HANGIL (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HANGIL
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 1:350 ENGLE STREET
Mailing Address - Street 2:1ST FLOOR BERRIE BUILDING
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-568-5250
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE STREET
Practice Address - Street 2:1ST FLOOR BERRIE BUILDING
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-568-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08469100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist