Individual
JIN TAE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1250 E MARSHALL ST, RADIOLOGY, RICHMOND, VA 23298-5051
(804) 628-3580
(804) 628-3593
Mailing address
8599 HAVEN AVE., SUITE 300, RANCHO CUCAMONGA, CA 91730-4849
(909) 620-8180
(909) 919-7288
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101245471
VA
2085R0202X
Diagnostic Radiology Physician
A73178
CA
2085R0202X
Diagnostic Radiology Physician
M5291
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195889402
—
TX
01
—
195889403
CSHCN
TX
01
—
8BC330
BCBSTX (BLUE CROSS BLUE SHIELD TEXAS)
TX
Enumeration date
03/25/2007
Last updated
07/22/2011
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