Healthcare Provider Details

I. General information

NPI: 1598164113
Provider Name (Legal Business Name): JIN AH KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

382 CENTRAL PARK W APT 17D
NEW YORK NY
10025-6037
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2885
  • Fax:
Mailing address:
  • Phone: 646-455-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number290240
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number290240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: