Individual
JASON KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 MARIKA RD, FAIRBANKS, AK 99709-5521
(907) 474-0890
Mailing address
1825 MARIKA RD, FAIRBANKS, AK 99709-5521
(907) 474-0890
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N.A
N.A
AK
Enumeration date
04/07/2020
Last updated
03/04/2021
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