Provider Demographics
NPI:1922461698
Name:KIM, JORDAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:L
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 1:1949 GUNBARREL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7133
Mailing Address - Country:US
Mailing Address - Phone:423-495-4345
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:320 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1609
Practice Address - Country:US
Practice Address - Phone:423-643-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine