Provider Demographics
NPI:1861666166
Name:JAE C KIM, MD, PC
Entity Type:Organization
Organization Name:JAE C KIM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-2975
Mailing Address - Street 1:5031 VILLA LINDE PKW
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3446
Mailing Address - Country:US
Mailing Address - Phone:810-732-2976
Mailing Address - Fax:810-732-0116
Practice Address - Street 1:5031 VILLA LINDE PKW
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3446
Practice Address - Country:US
Practice Address - Phone:810-732-2976
Practice Address - Fax:810-732-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty