Healthcare Provider Details

I. General information

NPI: 1922701747
Provider Name (Legal Business Name): KIVEUM KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

2555 SEYCHELLES DR UNIT 406
NAPLES FL
34112-3029
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4000
  • Fax:
Mailing address:
  • Phone: 404-698-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS23328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: