Provider Demographics
NPI:1114189552
Name:KIM, JENNIFER MEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MEGAN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1205
Mailing Address - Country:US
Mailing Address - Phone:727-525-2161
Mailing Address - Fax:727-527-1968
Practice Address - Street 1:5601 9TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1205
Practice Address - Country:US
Practice Address - Phone:727-525-2161
Practice Address - Fax:727-527-1968
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics