Basic Information
| Provider Information | |||||||||
| NPI: | 1609063387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JIN-YON | ||||||||
| MiddleName: | JEANY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | DEPT # 457 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015169183 | ||||||||
| FaxNumber: | 9015168993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 UNION AVE | ||||||||
| Address2: | SUITE 184 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015169183 | ||||||||
| FaxNumber: | 9015168993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 229503 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | A99274 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 49525 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | P01294157 | 01 | TN | RAILROAD MEDICARE | OTHER | 197290001 | 05 | AR | MEDICAID | 4355601 | 01 | TN | BCBS | OTHER | Q002438 | 05 | TN | MEDICAID | 06427772 | 05 | MS | MEDICAID |