1477843480 NPI number — CLAUDIA JIN KIM M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477843480 NPI number — CLAUDIA JIN KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
CLAUDIA
Provider Middle Name:
JIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477843480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1246 ASHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-453-0661
Provider Business Mailing Address Fax Number:
740-453-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2916 VANGADER DR
Provider Second Line Business Practice Location Address:
GENESIS SURGICAL ASSOCIATES
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-453-0661
Provider Business Practice Location Address Fax Number:
740-453-4940
Provider Enumeration Date:
04/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35.128586 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0170829 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com