Provider Demographics
NPI:1871850008
Name:KIM, JIN SOK
Entity Type:Individual
Prefix:MR
First Name:JIN
Middle Name:SOK
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1168
Mailing Address - Country:US
Mailing Address - Phone:907-274-0038
Mailing Address - Fax:907-222-0511
Practice Address - Street 1:401 W INTERNATIONAL AIRPORT RD
Practice Address - Street 2:SUITE 15
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1168
Practice Address - Country:US
Practice Address - Phone:907-274-0038
Practice Address - Fax:907-222-0511
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator