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NPI Code Detail

MEDICARE: JESSICA KIM

MEDICARE: JESSICA KIM
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
1390200000XStudent in an Organized Health Care Education/Training Program84829CT

General Provider Information

NPI Number : 1679259188
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KIM
Provider Business Mailing Address
First Line : 345 E 24TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10010-4020
Country : US
Telephone Number : 212-998-9800
Fax Number :
Provider Business Practice Location Address
First Line : 345 E 24TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10010-4020
Country : US
Telephone Number : 212-998-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2023
Last Update Date : 06/03/2026

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Directions to “ JESSICA KIM ” Practice Location

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