MEDICARE: JASON KIM DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	N007022	NY

General Provider Information

NPI Number	:	1497103220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KIM DPM

Provider Business Mailing Address
First Line	:	438 52ND ST
Second Line	:	APT B8
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2706
Country	:	US
Telephone Number	:	630-544-1406
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W 79TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6474
Country	:	US
Telephone Number	:	212-874-3578
Fax Number	:

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

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	04/05/2021

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Directions to “ JASON KIM DPM” Practice Location

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