Healthcare Provider Details

I. General information

NPI: 1679529069
Provider Name (Legal Business Name): TODD K KIM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333-41 STREET SUITE 322
MIAMI BEACH FL
33140
US

IV. Provider business mailing address

333-41 STREET SUITE 322
MIAMI BEACH FL
33140
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-7643
  • Fax: 305-534-0702
Mailing address:
  • Phone: 305-531-7643
  • Fax: 305-534-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0017134
License Number StateFL

VIII. Authorized Official

Name: TODD KIM
Title or Position: OWNER
Credential: MD
Phone: 305-531-7643