MEDICARE: JOSEPH B KIM MD

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	01082581A	IN
2	2083P0901X	Public Health & General Preventive Medicine Physician	01082581A	IN
3	208D00000X	General Practice Physician	01082581A	IN
4	2083X0100X	Occupational Medicine Physician	01082581A	IN

General Provider Information

NPI Number	:	1245736594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH B KIM MD

Provider Business Mailing Address
First Line	:	PSC 482 BOX 2959
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362-0030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	676FUTENMA
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362-0030
Country	:	US
Telephone Number	:	315-646-9619
Fax Number	:

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	02/07/2025

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