Basic Information
| Provider Information | |||||||||
| NPI: | 1295724722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE #301 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 17TH & CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD033318L | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0006220470002 | 05 | PA | MEDICAID | 00622047 | 01 | PA | GATEWAY | OTHER | 1010374 | 01 | PA | KEYSTONE MERCY | OTHER | 0040561000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 000000110351 | 01 | PA | THREE RIVERS | OTHER | 0095712 | 01 | PA | KHP CENTRAL | OTHER | 095712 | 01 | PA | HIGHMARK | OTHER | 1010374 | 01 | PA | AMERIHEALTH MERCY | OTHER |