Provider Demographics
NPI:1811928245
Name:KIM, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:341 COOL SPRINGS BLVD.
Mailing Address - Street 2:STE. 400
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:423-508-7337
Mailing Address - Fax:423-508-7338
Practice Address - Street 1:7268 JARNIGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3097
Practice Address - Country:US
Practice Address - Phone:423-508-7337
Practice Address - Fax:423-508-7338
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061571A207W00000X
TNMD-52348207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01061571AOtherMEDICAL LICENSE
INP00985648OtherRR MEDICARE
IN200821890Medicaid
IN4823160002Medicare NSC
IN200821890Medicaid
INP00985648OtherRR MEDICARE
H20058Medicare UPIN
IN4823160004Medicare NSC
IN4823160003Medicare NSC