Provider Demographics
NPI:1316635568
Name:KIM, JIN BUM (MD)
Entity type:Individual
Prefix:DR
First Name:JIN BUM
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE GUTHRIE SQUARE GRADUATE
Mailing Address - Street 2:MEDICAL EDUCATION GUTHRIE/ROBERT PACKER HOSPITAL
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840
Mailing Address - Country:US
Mailing Address - Phone:570-888-6666
Mailing Address - Fax:
Practice Address - Street 1:ONE GUTHRIE SQUARE GRADUATE
Practice Address - Street 2:MEDICAL EDUCATION GUTHRIE/ROBERT PACKER HOSPITAL
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840
Practice Address - Country:US
Practice Address - Phone:570-888-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program