Healthcare Provider Details

I. General information

NPI: 1942211388
Provider Name (Legal Business Name): JOO YON KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 NORTH WILLIAMSON BLVD
DAYTONA BEACH FL
32117-5250
US

IV. Provider business mailing address

51 WATERBLUFF DR
ORMOND BEACH FL
32174-3076
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 407-513-9346
Mailing address:
  • Phone: 386-852-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME74429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: