MEDICARE: JOANNE KIM

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922949957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE KIM

Provider Business Mailing Address
First Line	:	10129 CROSSING WAY STE 400
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5892
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10129 CROSSING WAY STE 400
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5892
Country	:	US
Telephone Number	:	225-788-1400
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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Directions to “ JOANNE KIM ” Practice Location

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