MEDICARE: ROBERT KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS18450	FL
2	207Q00000X	Family Medicine Physician	OS18450	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265923841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KIM

Provider Business Mailing Address
First Line	:	4109 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:	954-563-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:	954-563-2707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2018
Last Update Date	:	03/09/2025

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