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General NPI Number Information
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NPI Number | 1497017289
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Entity Type | Individual
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Provider Name | KIRSTEN S. KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 870 DUNLAWTON AVE STE 311
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City | PORT ORANGE
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State | FL
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Zip | 32127-9274
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Country | US
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Telephone | 386-310-4807
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Fax | 863-107-4733
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Provider Business Mailing Address
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Address Line | 870 DUNLAWTON AVE STE 311
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City | PORT ORANGE
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State | FL
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Zip | 32127-9274
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Country | US
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Telephone | 386-310-4807
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Fax | 386-310-7473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME117574
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License Number State | FL
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