Provider Demographics
NPI:1225187388
Name:KIM, JAMIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18111 BROOKHURST ST #4450
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-848-2383
Mailing Address - Fax:714-848-4083
Practice Address - Street 1:18111 BROOKHURST ST #4450
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-848-2383
Practice Address - Fax:714-848-4083
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G835810Medicaid
CA1225187388OtherINDIVIDUAL NPI
CA00G835810Medicaid
CAW15938Medicare UPIN
CAWG83581AMedicare PIN