Provider Demographics
NPI:1215138458
Name:KIM, JIEUN (MD)
Entity type:Individual
Prefix:DR
First Name:JIEUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:503 WASHIGTON AVENUE, SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2222
Mailing Address - Country:US
Mailing Address - Phone:215-771-1434
Mailing Address - Fax:866-721-3170
Practice Address - Street 1:921B N BETHLEHEM PIKE STE 305
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-1319
Practice Address - Country:US
Practice Address - Phone:215-771-1434
Practice Address - Fax:866-721-3170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4350862084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161230Medicare PIN