Physician Compare National (NPI:1639358211)

HEALTHCARE PROVIDER: KING KIM D.M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639358211
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9436321874
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111007000466
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	KING
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	MAXILLOFACIAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NEW IMAGE MAXILLOFACIAL LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6800029331
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	7155 TURNER RD
	Group Practice or individual's line 1 address
City	ROCKLEDGE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	329555712
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3212557724
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y