Provider Demographics
NPI:1316095573
Name:GOLD KIMBALL INTERNATIONAL, INC.
Entity type:Organization
Organization Name:GOLD KIMBALL INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAOYING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-367-0688
Mailing Address - Street 1:2080 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2015
Mailing Address - Country:US
Mailing Address - Phone:732-367-0688
Mailing Address - Fax:
Practice Address - Street 1:2080 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2015
Practice Address - Country:US
Practice Address - Phone:732-367-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006225003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9062009Medicaid
NJ9062017Medicaid
NJ3145174OtherNABP
NJ9062017Medicaid