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General NPI Number Information
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NPI Number | 1891769113
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Entity Type | Individual
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Provider Name | JANET JAYON KIM MD
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 12/31/2016
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Provider Practice Location Address
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Address Line | 2079 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1735
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Country | US
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Telephone | 718-815-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 2079 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1865
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Country | US
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Telephone | 917-348-6291
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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 | 238148
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 238148
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License Number State | NY
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