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NPI Code Detail

MEDICARE: MISS JAIMY VILLAVICENCIO KIM M.D.

MEDICARE: MISS JAIMY VILLAVICENCIO KIM M.D.
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
1207RT0003XTransplant Hepatology Physician84604-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356839062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JAIMY VILLAVICENCIO KIM M.D.
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 2900 W OKLAHOMA AVE FL 5
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4330
Country : US
Telephone Number : 414-646-1550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2018
Last Update Date : 09/18/2025

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