Healthcare Provider Details

I. General information

NPI: 1215506720
Provider Name (Legal Business Name): JASMINE MARIAH KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NW MYHRE RD FL 3
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1950 NW MYHRE RD FL 3
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-4200
  • Fax: 564-240-4299
Mailing address:
  • Phone: 564-240-4200
  • Fax: 564-240-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.MD.70118340
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: