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General NPI Number Information
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NPI Number | 1427126465
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Entity Type | Organization
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Legal Business Name | MILFORD MEDICAL CARE CENTER PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 889 BRIDGEPORT AVE
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 203-783-9899
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Fax | 203-877-9538
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Provider Business Mailing Address
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Address Line | 889 BRIDGEPORT AVE
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 203-783-9899
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Fax | 203-877-9538
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JAE JIN KIM
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Credential | MD, PHD
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Telephone | 203-783-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 019395
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License Number State | CT
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