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General NPI Number Information
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NPI Number | 1275441008
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Entity Type | Organization
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Legal Business Name | NORTHSTAR PROFESSIONAL GROUP PA
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 17075 CAGAN RIDGE BLVD STE 103
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City | CLERMONT
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State | FL
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Zip | 34714-9619
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Country | US
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Telephone | 818-523-7253
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Fax |
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Provider Business Mailing Address
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Address Line | 17075 CAGAN RIDGE BLVD STE 103
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City | CLERMONT
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State | FL
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Zip | 34714-9619
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Country | US
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Telephone | 818-523-7253
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHIN KIM
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Credential | DDS
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Telephone | 818-523-7253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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