Provider Demographics
NPI:1528323714
Name:KIM, JUNG (RD LDN CNSD)
Entity type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RD LDN CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1702
Mailing Address - Country:US
Mailing Address - Phone:267-210-3551
Mailing Address - Fax:
Practice Address - Street 1:540 ASHBOURNE RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1702
Practice Address - Country:US
Practice Address - Phone:267-210-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered