Healthcare Provider Details

I. General information

NPI: 1518347988
Provider Name (Legal Business Name): JENNIE KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE MAIMONIDES MEDICAL CENTER
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

5402 FORT HAMILTON PKWY 6TH FLOOR
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8000
  • Fax:
Mailing address:
  • Phone: 718-283-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number339907
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA173096
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA173096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: