MEDICARE: JAE S KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME0041878	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396769519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE S KIM M.D.

Provider Business Mailing Address
First Line	:	5840 W COLONIAL DR
Second Line	:	STE 1
City	:	ORLANDO
State	:	FL
Zip	:	32808-7558
Country	:	US
Telephone Number	:	407-767-8554
Fax Number	:	407-767-9121

Provider Business Practice Location Address
First Line	:	5840 W COLONIAL DR
Second Line	:	STE 1
City	:	ORLANDO
State	:	FL
Zip	:	32808-7558
Country	:	US
Telephone Number	:	407-767-8554
Fax Number	:	407-767-9121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/13/2013

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