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General NPI Number Information
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NPI Number | 1518358316
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Entity Type | Individual
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Provider Name | MR. DONG JIN KIM
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Gender | Male
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Dates
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Enumeration Date | 02/15/2015
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Last Update Date | 02/15/2015
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Provider Practice Location Address
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Address Line | 1651 SE US HIGHWAY 19
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4830
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Country | US
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Telephone | 352-794-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 195 E HARTFORD ST APT 7A
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City | HERNANDO
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State | FL
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Zip | 34442-3390
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Country | US
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Telephone | 352-419-0220
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS41788
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License Number State | FL
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