Healthcare Provider Details

I. General information

NPI: 1134562051
Provider Name (Legal Business Name): ELLIOTT JIWOO KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HAYES ST STE 200
NASHVILLE TN
37203-2689
US

IV. Provider business mailing address

2004 HAYES ST STE 200
NASHVILLE TN
37203-2689
US

V. Phone/Fax

Practice location:
  • Phone: 615-324-1600
  • Fax: 615-324-1661
Mailing address:
  • Phone: 615-324-1600
  • Fax: 615-324-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number80032
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number55217
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: