Active NPI
Jin Kim, MD
- Anesthesiology Physician
- Allentown, PA
National Provider Identifier
1295724722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD033318L
- Practice address
- 17TH & Chew St
Allentown, PA 18102 - Phone
- (610) 402-9080
- Fax
- (610) 402-9029
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD033318L | PA | Primary |
Addresses
Primary practice location
17TH & Chew St
Allentown, PA 18102
Mailing address
1245 S Cedar Crest Blvd
Suite #301
Allentown, PA 18103-6258
Phone (610) 402-9080
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006220470002 | Medicaid | PA | |
| 00622047 | Other | PA | GATEWAY |
| 1010374 | Other | PA | KEYSTONE MERCY |
| 0040561000 | Other | PA | INDEP. BLUE CROSS |
| 000000110351 | Other | PA | THREE RIVERS |
| 0095712 | Other | PA | KHP CENTRAL |
| 095712 | Other | PA | HIGHMARK |
| 1010374 | Other | PA | AMERIHEALTH MERCY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD033318L | PA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196899200000",
"number": "1295724722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 S CEDAR CREST BLVD",
"address_2": "SUITE #301",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "181036258",
"telephone_number": "610-402-9080",
"fax_number": "610-402-9029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17TH & CHEW ST",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "18102",
"telephone_number": "610-402-9080",
"fax_number": "610-402-9029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2007-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "PA",
"license": "MD033318L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006220470002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "00622047",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "1010374",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEP. BLUE CROSS",
"identifier": "0040561000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THREE RIVERS",
"identifier": "000000110351",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KHP CENTRAL",
"identifier": "0095712",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK",
"identifier": "095712",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH MERCY",
"identifier": "1010374",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Allentown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.