Provider Demographics
NPI:1982880605
Name:KIM, JOHNSTONE MINSOK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNSTONE
Middle Name:MINSOK
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 1:6655 POST RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8265
Mailing Address - Country:US
Mailing Address - Phone:614-339-8500
Mailing Address - Fax:614-339-8501
Practice Address - Street 1:6655 POST RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8265
Practice Address - Country:US
Practice Address - Phone:614-339-8500
Practice Address - Fax:614-339-8501
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64579207W00000X
MI4301098040207W00000X
NY268617207W00000X
OH35129264207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP30630764Medicare PIN