Provider Demographics
NPI:1093739146
Name:JAE S KIM MD PA
Entity Type:Organization
Organization Name:JAE S KIM MD PA
Other - Org Name:HEART CARE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,TREASURER,SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-291-2440
Mailing Address - Street 1:5840 W COLONIAL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7558
Mailing Address - Country:US
Mailing Address - Phone:407-291-2440
Mailing Address - Fax:407-290-8966
Practice Address - Street 1:5840 W COLONIAL DR
Practice Address - Street 2:STE 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7558
Practice Address - Country:US
Practice Address - Phone:407-291-2440
Practice Address - Fax:407-290-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041878207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067741800Medicaid
FL47570OtherBCBS OF FLORIDA
FL067741800Medicaid
FL47570OtherBCBS OF FLORIDA