Healthcare Provider Details

I. General information

NPI: 1912753757
Provider Name (Legal Business Name): SEORYEON KIM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S ROYAL POINCIANA BLVD STE 100
MIAMI SPRINGS FL
33166-6667
US

IV. Provider business mailing address

2569 SW 119TH WAY
MIRAMAR FL
33025-5694
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-9223
  • Fax:
Mailing address:
  • Phone: 301-875-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberAPRN11032248
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAPRN11032248
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAPRN11032248
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: