Provider Demographics
NPI:1396158069
Name:KIM, LUKE YOUNG JOONG (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:YOUNG JOONG
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 1:1001 SHEPPARD RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4796
Mailing Address - Country:US
Mailing Address - Phone:856-772-1617
Mailing Address - Fax:856-229-7850
Practice Address - Street 1:1001 SHEPPARD RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4796
Practice Address - Country:US
Practice Address - Phone:856-772-1617
Practice Address - Fax:856-229-7850
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10498800207Y00000X
PAMD462595207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology