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Individual

JAY J KIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
730 W MARKET ST STE 2K, LIMA, OH 45801-4602
(419) 996-4011
(419) 996-4012
Mailing address
730 W MARKET ST STE 2K, LIMA, OH 45801-4602
(419) 996-4011
(419) 996-4012

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
18287
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000433626
OHIO MEDICAID UNISON
OH
05
0129081000
WV
01
2493789
OH MEDICAID MOLINA
OH
05
2493789
OH
01
310917085258
OH MEDICAID CARESOURCE
OH
Enumeration date
01/11/2006
Last updated
11/05/2020
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