Individual
JIMMY LEE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5900 S LAKE DR, CUDAHY, WI 53110-3171
(414) 489-4190
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
51366-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35296800
—
WI
01
—
P00700734
RR MEDICARE
WI
Enumeration date
10/03/2006
Last updated
10/31/2023
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