Healthcare Provider Details

I. General information

NPI: 1164498978
Provider Name (Legal Business Name): JAMIE KIM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE WON

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 98TH STREET 14TH FL
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL. BOX 1263
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4585
  • Fax: 212-987-9310
Mailing address:
  • Phone: 212-241-4585
  • Fax: 212-987-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010037
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: