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Individual

DR. JOHN RAPHAEL KIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4946
Mailing address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4946

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10142685
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0983280
OH
05
100376180
IN
01
300039257
MEDICARE RAILROAD
IN
01
300077566
MEDICARE RAILROAD
IN
Enumeration date
01/27/2006
Last updated
12/16/2009
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