Provider Demographics
NPI:1295734762
Name:KIM, JAE CHUL (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:CHUL
Last Name:KIM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5031 VILLA LINDE PKWY
Mailing Address - Street 2:STE 20
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3448
Mailing Address - Country:US
Mailing Address - Phone:810-732-2975
Mailing Address - Fax:810-732-0116
Practice Address - Street 1:5031 VILLA LINDE PKWY
Practice Address - Street 2:STE 20
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3448
Practice Address - Country:US
Practice Address - Phone:810-732-2975
Practice Address - Fax:810-732-0116
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-04-16
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Provider Licenses
StateLicense IDTaxonomies
MIJK0405092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1579441Medicaid
MI1579441Medicaid
MI0253225Medicare ID - Type Unspecified