Kim, John Raphael

Kim, John Raphael is an individual health care provider with primary practice located at 6119 W Jefferson Blvd , Fort Wayne IN 46804-3072. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Kim, John Raphael can be contacted via phone (260) 432-1568.

Contact Information

Primary practice address
6119 W Jefferson Blvd Fort Wayne IN 46804-3072
Phone: (260) 432-1568
Fax: (260) 432-4946
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 10142685 Indiana

Profile Details

NPI number 1710958848
LBN Legal business name Kim, John Raphael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Dec 16th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710958848 NPPES
Indiana Other 300077566 MEDICARE RAILROAD
Indiana MEDICAID 0983280 MEDICARE RAILROAD
Indiana Other 300039257 MEDICARE RAILROAD
Indiana MEDICAID 100376180 MEDICARE RAILROAD

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