Healthcare Provider Details

I. General information

NPI: 1225117005
Provider Name (Legal Business Name): JOHN KIM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

40 NE 2ND AVE
DEERFIELD BEACH FL
33441-3504
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-7100
  • Fax:
Mailing address:
  • Phone: 954-426-8840
  • Fax: 954-426-6641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0077868
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN D KIM
Title or Position: PRESIDENT
Credential: MD PA
Phone: 954-426-8840