JEONGWON KIM MD (Credential# 375264) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
JEONGWON KIM MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0035329. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 279 Tremont Avenue, Fort Lee, NJ 07024. The current status is active.
| Licensee Name | JEONGWON KIM MD |
| Credential ID | 375264 |
| Credential Number | CSP.0035329 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
279 Tremont Avenue Fort Lee NJ 07024 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2004-07-06 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-22 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 559980 | 1.042398 | Physician/Surgeon | 2004-05-04 | 2019-11-01 - 2020-10-31 | ACTIVE |
| Street Address | 279 Tremont Avenue |
| City | FORT LEE |
| State | NJ |
| Zip Code | 07024 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eun Kim | 1263a Inwood Terrace, Fort Lee, NJ 07024 | Pharmacist | ~ |
| Stephen C Leventis | 2125 Center Ave Ste 301, Fort Lee, NJ 07024 | Architect | 2020-08-01 ~ 2021-07-31 |
| Taeik Kim | 2029 Lemoine Ave. Suite 302, Fort Lee, NJ 07024 | Architect | 2020-08-01 ~ 2021-07-31 |
| Catalina A Grigorescu | 270 Bluff Road, Fort Lee, NJ 07024 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shaina Rodrigues | 2461 8th Street, Fort Lee, NJ 07024 | Resident Physician | 2020-06-28 ~ 2021-06-30 |
| Daniel William Livshin | 3406 Crest Ln, Fort Lee, NJ 07024 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Robert Abraham | 296 Harmon Ave., Fort Lee, NJ 07024 | Radiographer | 2020-06-01 ~ 2021-05-31 |
| Marge Teilhaber | 555 North Avenue 6 T, Fort Lee, NJ 07024 | Notary Public Appointment | 2015-04-01 ~ 2020-03-31 |
| Andrew J Merin | 4 Ascot Way, Fort Lee, NJ 07024 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| Seungjin Kim | 2050 Central Road Apt 718, Fort Lee, NJ 07024 | Dentist | 2020-02-20 ~ 2021-02-28 |
| Find all Licenses in zip 07024 | |||
| City | FORT LEE |
| Zip Code | 07024 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + FORT LEE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Erin K Fee | CT | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Min Jin Kim | 639 4th Ave Apt 5c, Brooklyn, NY 11232-1048 | Controlled Substance Registration for Practitioner | 2012-05-10 ~ 2013-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Hae J Kim Pa | New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2008-03-31 ~ 2009-02-28 |
| Arundati Rao | CT | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Huu Duc D Luu | 630 Mix Ave Apt 6p, Hamden, CT 06514-2320 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Jessica Li | Stamford, CT 06904 | Controlled Substance Registration for Practitioner | 2016-08-31 ~ 2017-02-28 |
| Sue A Smolski | 55 Nye Rd Ste 102, Glastonbury, CT 06033 | Controlled Substance Registration for Practitioner | 2015-05-21 ~ 2017-02-28 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).