Healthcare Provider Details

I. General information

NPI: 1912319047
Provider Name (Legal Business Name): ALEXANDER YOUNGJOON KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S STE C520
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

601 5TH ST S STE C520
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8491
  • Fax: 727-767-8270
Mailing address:
  • Phone: 727-767-8491
  • Fax: 727-767-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME132543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: