Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 227412 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME99852 | FL |
NPI | 1285686154 |
---|---|
Provider Name | Kyu Kim Jana |
First Address | Galveston, TX 77555-1250 |
Second Address | Galveston, TX 77555-1250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 27/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00026166201 | UNIVERA # (01) | NY |
000527217002 | HEALTH NOW BCBS # (01) | NY |
040426003337 | FIDELIS CARE # (01) | NY |
0492681 | IHA # (01) | NY |
159651BF | PREFERRED CARE # (01) | NY |
5996171 | GHI PPO # (01) | NY |
G54625 | (02) | |
P00189134 | MEDICARE RAILROAD # (01) | NY |