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General NPI Number Information
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NPI Number | 1164981965
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Entity Type | Individual
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Provider Name | JAE HOON KIM DO
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 3535 W 13 MILE RD STE 247
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City | ROYAL OAK
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State | MI
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Zip | 48073-6770
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Country | US
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Telephone | 248-551-4149
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Fax | 248-551-4150
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 248-551-4149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LP04718
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | OL61280717
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 5101027937
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License Number State | MI
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