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General NPI Number Information
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NPI Number | 1093739146
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Entity Type | Organization
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Legal Business Name | JAE S KIM MD PA
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 5840 W COLONIAL DR STE 1
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City | ORLANDO
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State | FL
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Zip | 32808-7558
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Country | US
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Telephone | 407-291-2440
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Fax | 407-290-8966
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Provider Business Mailing Address
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Address Line | 5840 W COLONIAL DR STE 1
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City | ORLANDO
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State | FL
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Zip | 32808-7558
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Country | US
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Telephone | 407-291-2440
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Fax | 407-290-8966
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Authorized Official
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Title or Position | PRESIDENT,TREASURER,SECRETARY
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Name | DR. JAE S KIM
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Credential | M.D.
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Telephone | 407-291-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0041878
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License Number State | FL
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