Provider Demographics
NPI:1467511659
Name:KIM, JASON JEHO (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JEHO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 140
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 E 61ST ST
Practice Address - Street 2:PENTHOUSE FLOOR SUITE 13-16
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8722
Practice Address - Country:US
Practice Address - Phone:212-821-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2126382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087BH1Medicare PIN
NYH55477Medicare UPIN