Provider Demographics
NPI:1669637948
Name:MASTERS, JENNA KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:KIM
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:YEON
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2633
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40934207L00000X
WAMD60288088207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01099021OtherRAILROAD MEDICARE PTAN
WA0297103OtherLABOR AND INDUSTRY
WA1669637948Medicaid
WA1669637948Medicaid