Healthcare Provider Details

I. General information

NPI: 1003410606
Provider Name (Legal Business Name): YEO WHOA KANG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12804 US HIGHWAY 301
DADE CITY FL
33525-5801
US

IV. Provider business mailing address

1726 WHITEWILLOW DR
WESLEY CHAPEL FL
33543-5480
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-5656
  • Fax:
Mailing address:
  • Phone: 904-252-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: