Provider Demographics
NPI:1043207871
Name:KIM, JIN-HEE (MD)
Entity type:Individual
Prefix:DR
First Name:JIN-HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:501 N GRAHAM ST STE 420
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2006
Practice Address - Country:US
Practice Address - Phone:503-288-7303
Practice Address - Fax:503-288-3806
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23590208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8383135Medicaid
OR286526Medicaid
H60853OtherPROVIDENCE HEALTH
003395000OtherBLUE CROSS OR ALL
WA8383135Medicaid
003395018OtherBLUE CROSS OR ALL
WA161519OtherDEPT OF LABOR A
OR286526Medicaid
A021OtherTRICARE
0000WCGCNMedicare ID - Type Unspecified
WA8383135Medicaid
OR286526Medicaid
H60853Medicare UPIN
OR181306Medicare PIN