Individual
JASON K KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4414 LAKE BOONE TRL, RALEIGH, NC 27607-7513
(919) 784-2300
(919) 784-2301
Mailing address
4414 LAKE BOONE TRL STE 505, RALEIGH, NC 27607-7521
(919) 784-2300
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2012-02076
NC
2086S0129X
Vascular Surgery Physician
Primary
2012-02076
NC
2086S0129X
Vascular Surgery Physician
252638
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1050075
—
LA
Enumeration date
07/31/2007
Last updated
04/01/2021
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