MEDICARE: DR. JANE KIM MD

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	207P00000X	Emergency Medicine Physician	263667	NY

General Provider Information

NPI Number	:	1588826119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE KIM MD

Provider Business Mailing Address
First Line	:	450 CLARKSON AVE
Second Line	:	MAILBOX 1228
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2012
Country	:	US
Telephone Number	:	718-245-4790
Fax Number	:	718-245-4799

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVE
Second Line	:	MAILBOX 1228
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2012
Country	:	US
Telephone Number	:	718-245-4790
Fax Number	:	718-245-4799

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	05/16/2012

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