Healthcare Provider Details

I. General information

NPI: 1275870842
Provider Name (Legal Business Name): JAMIE KIM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST SUITE 510
SAN FRANCISCO CA
94117-1016
US

IV. Provider business mailing address

1 SHRADER ST SUITE 510
SAN FRANCISCO CA
94117-1016
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-2014
  • Fax: 415-759-2015
Mailing address:
  • Phone: 415-759-2014
  • Fax: 415-759-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL1846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberEL1846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: