Healthcare Provider Details

I. General information

NPI: 1699416644
Provider Name (Legal Business Name): DESMOND KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME181010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: