MEDICARE: DR. HYUNJU JANE IM 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	208000000X	Pediatrics Physician	60900	CT

General Provider Information

NPI Number	:	1508109893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUNJU JANE IM MD

Provider Business Mailing Address
First Line	:	53 70TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1113
Country	:	US
Telephone Number	:	212-729-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 WASHINGTON ST
Second Line	:	MEDICAL EDUCATION, 4H
City	:	HARTFORD
State	:	CT
Zip	:	06106
Country	:	US
Telephone Number	:	860-545-9973
Fax Number	:	860-545-9973

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

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/14/2022

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