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General NPI Number Information
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NPI Number | 1518594647
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Entity Type | Individual
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Provider Name | AMY JUNG IN KIM MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 5440 S WILLIAMSON BLVD UNIT 104
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City | PORT ORANGE
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State | FL
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Zip | 32128-7422
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Country | US
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Telephone | 386-425-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 S WILLIAMSON BLVD FL 32128
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City | PORT ORANGE
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State | FL
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Zip | 32128-7422
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 161610
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License Number State | FL
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