DR. JACOB JUNHYUK IM MD
NPI 1366183204
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since April 05, 2022PECOS Enrolled
4717 SAINT ANTOINE ST, DETROIT, MI 48201(313) 577-7614 Get Directions Write a Review

NPPES record last updated: April 5, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Jacob Junhyuk Im Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACOB JUNHYUK IM MD (NPI 1366183204) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366183204
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. JACOB JUNHYUK IMCredential: MD
Location Address4717 SAINT ANTOINE STDetroit, MI 48201-1423
Mailing Address955 Ouellette Ave, Unit 303Windsor, ONTARIO N9A 4J5
Sole ProprietorNo
Enumeration DateApril 5, 2022
NPPES CertifiedApril 5, 2022
NPI 1366183204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4717 SAINT ANTOINE ST, Detroit, MI 48201

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Jacob Junhyuk Im Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Ophthalmology
4717 SAINT ANTOINE ST, KRESGE EYE INSTITUTE
DETROIT, MI 48201
Optometrist
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Student in an Organized Health Care Education/Training Program
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Student in an Organized Health Care Education/Training Program
4717 SAINT ANTOINE ST
DETROIT, MI 48201

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Im's NPI number?

The NPI number for Jacob Im is 1366183204. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Where is Jacob Im located?

Jacob Im practices at 4717 Saint Antoine St, Detroit, MI 48201. The listed phone number is (313) 577-7614.

What is Jacob Im's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Im enrolled in Medicare?

Yes. Jacob Im is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Im was last updated on April 5, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.