Provider Demographics
NPI:1922000447
Name:KIM, JAY H (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 BISCAYNE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1252
Mailing Address - Country:US
Mailing Address - Phone:305-918-0742
Mailing Address - Fax:305-918-0787
Practice Address - Street 1:21110 BISCAYNE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1252
Practice Address - Country:US
Practice Address - Phone:305-918-0742
Practice Address - Fax:305-918-0787
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78947208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2338521OtherAETNA
FLN215632OtherWELLCARE
FLP00296874OtherRAILROAD MEDICARE
FLD10849OtherVISTA
FL7524115OtherAETNA
FL224183OtherAMERIGROUP
FL49742OtherBCBS
FL262898OtherAVMED
FL8203206OtherCIGNA
FLP00296874OtherRAILROAD MEDICARE
FLH09000Medicare UPIN
FLE3517WMedicare PIN
FLD10849OtherVISTA
FLE3517YMedicare PIN