Provider Demographics
NPI:1245295765
Name:KIM, JUN OH (MD)
Entity type:Individual
Prefix:
First Name:JUN
Middle Name:OH
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:4002 KRESGE WAY
Practice Address - Street 2:SUITE 124
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4661
Practice Address - Country:US
Practice Address - Phone:502-895-4263
Practice Address - Fax:502-899-5488
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000350555OtherANTHEM - NMA
1165019OtherPASSPORT - NMA
9332831006OtherCIGNA / NMA
009893OtherSIHO - NMA
2439903000OtherPAD - NMA
KY64047855Medicaid
KYP00180631OtherRRMCR - NMA
1193586OtherCHA / NMA
9332831006OtherCIGNA / NMA
KY0361977Medicare PIN