Healthcare Provider Details

I. General information

NPI: 1356995062
Provider Name (Legal Business Name): DR. MIN KYEONG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-2000
  • Fax:
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30227
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN30227
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12609
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: