Provider Demographics
NPI:1295724722
Name:KIM, JIN (MD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
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 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9080
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:17TH & CHEW ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-402-9080
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033318L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006220470002Medicaid
PA00622047OtherGATEWAY
PA1010374OtherKEYSTONE MERCY
PA0040561000OtherINDEP. BLUE CROSS
PA000000110351OtherTHREE RIVERS
PA0095712OtherKHP CENTRAL
PA095712OtherHIGHMARK
PA1010374OtherAMERIHEALTH MERCY
PA095712OtherHIGHMARK
PA095712EU8Medicare PIN