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NPI Code Detail

MEDICARE: DR. JOHN RAPHAEL KIM MD

MEDICARE: DR. JOHN RAPHAEL 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
12085R0202XDiagnostic Radiology Physician10142685IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300077566OTHERINMEDICARE RAILROAD
3300039257OTHERINMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710958848
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN RAPHAEL KIM MD
Provider Business Mailing Address
First Line : 6119 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-3072
Country : US
Telephone Number : 260-432-1568
Fax Number : 260-432-4946
Provider Business Practice Location Address
First Line : 6119 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-3072
Country : US
Telephone Number : 260-432-1568
Fax Number : 260-432-4946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 12/16/2009

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Directions to “ DR. JOHN RAPHAEL KIM MD” Practice Location

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