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NPI Code Detail

MEDICARE: DR. JANET JAYON KIM MD

MEDICARE: DR. JANET JAYON 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
1207R00000XInternal Medicine Physician238148NY
2208000000XPediatrics Physician238148NY

General Provider Information

NPI Number : 1891769113
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JANET JAYON KIM MD
Provider Business Mailing Address
First Line : 2079 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-1865
Country : US
Telephone Number : 917-348-6291
Fax Number :
Provider Business Practice Location Address
First Line : 2079 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-1735
Country : US
Telephone Number : 718-815-6560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 12/31/2016

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