Provider Demographics
NPI:1497785810
Name:KIM, JANE K (DO)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:K
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:10243 GENETIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-6310
Mailing Address - Country:US
Mailing Address - Phone:858-526-6100
Mailing Address - Fax:858-526-6126
Practice Address - Street 1:10243 GENETIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-6310
Practice Address - Country:US
Practice Address - Phone:858-526-6100
Practice Address - Fax:858-526-6126
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9078207Q00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A9078BMedicare Oscar/Certification