Jae Kim, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036056328 Issued in IL

Legal business name

JAE KIM, M.D.

Practice address

210 W Walnut St
Canton, IL 61520-2444

Phone

(309) 647-5240

Fax

(309) 647-5104

NPI assigned

Jun 10, 2006

Last updated

May 1, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jae K Kim, M.D.NPI 1316981491

Title

Owner

Phone

(309) 671-8749

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jae K Kim, M.D.

  • Anesthesiology Physician
  • Canton, IL
  • NPI 1316981491
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1710928627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7309 N KNOXVILLE AVE",
            "address_2": "SUITE 200",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142085",
            "telephone_number": "309-691-6225",
            "fax_number": "309-691-7635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W WALNUT ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202444",
            "telephone_number": "309-647-5240",
            "fax_number": "309-647-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAE KIM, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JAE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-671-8749",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036056328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056328",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00945642",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Canton, IL
• Providers in Canton, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.