Healthcare Provider Details

I. General information

NPI: 1679413215
Provider Name (Legal Business Name): JAEYUP KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDUCATION OFFICE, DEPARTMENT OF PSYCHIATRY 701 W. PRATT ST. RM 474
BALTIMORE MD
21201
US

IV. Provider business mailing address

EDUCATION OFFICE, DEPARTMENT OF PSYCHIATRY 701 W. PRATT ST. RM 474
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: