MEDICARE: DR. YANG JA 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
1	174400000X	Specialist	ME0017135	FL

General Provider Information

NPI Number	:	1477553667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANG JA KIM M.D.

Provider Business Mailing Address
First Line	:	4300 ALTON RD
Second Line	:	RADIOLOGY DEPARTMENT
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2800
Country	:	US
Telephone Number	:	305-674-2684
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 RUE FONTAINBLEAU
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5920
Country	:	US
Telephone Number	:	949-706-5662
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/04/2011

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