Provider Demographics
NPI:1467791871
Name:KIM, JENNIFER E
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 RUTLAND AVENUE
Mailing Address - Street 2:THE JOHNS HOPKINS SCHOOL OF MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2109
Mailing Address - Country:US
Mailing Address - Phone:410-955-3080
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:THE JOHNS HOPKINS HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-2109
Practice Address - Country:US
Practice Address - Phone:410-955-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52-0595110207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery