MEDICARE: JASON KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	01087088A	IN

General Provider Information

NPI Number	:	1174028997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KIM

Provider Business Mailing Address
First Line	:	9002 N MERIDIAN ST STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2301
Country	:	US
Telephone Number	:	317-844-5530
Fax Number	:

Provider Business Practice Location Address
First Line	:	9002 N MERIDIAN ST STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2301
Country	:	US
Telephone Number	:	317-844-5530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2018
Last Update Date	:	09/29/2022

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Directions to “ JASON KIM ” Practice Location

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