Provider Demographics
NPI:1538356043
Name:KIM, JI WOON (MD)
Entity type:Individual
Prefix:
First Name:JI
Middle Name:WOON
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 IRWON-RO, GANGNAM-GU
Mailing Address - Street 2:INTERNATIONAL HEALTHCARE CENTER
Mailing Address - City:SEOUL
Mailing Address - State:KOREA
Mailing Address - Zip Code:06351
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 IRWON-RO, GANGNAM-GU
Practice Address - Street 2:INTERNATIONAL HEALTHCARE CENTER
Practice Address - City:SEOUL
Practice Address - State:KOREA
Practice Address - Zip Code:06351
Practice Address - Country:KR
Practice Address - Phone:822-341-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036726207R00000X
NY250385207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine