Provider Demographics
NPI:1477843480
Name:KIM, CLAUDIA JIN (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JIN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1246 ASHLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-453-0661
Mailing Address - Fax:740-453-4940
Practice Address - Street 1:2916 VANGADER DR
Practice Address - Street 2:GENESIS SURGICAL ASSOCIATES
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1744
Practice Address - Country:US
Practice Address - Phone:740-453-0661
Practice Address - Fax:740-453-4940
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.128586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170829Medicaid