MEDICARE: P JOHN KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134511462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P JOHN KIM MD

Provider Business Mailing Address
First Line	:	18635 NW US HIGHWAY 441
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8708
Country	:	US
Telephone Number	:	386-454-2724
Fax Number	:	386-454-2899

Provider Business Practice Location Address
First Line	:	18635 NW US HIGHWAY 441
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8708
Country	:	US
Telephone Number	:	386-454-2724
Fax Number	:	386-454-2899

Authorized Official
Title or Position	:	OWNER
Name	:	DR. P JOHN KIM
Credential	:	MD
Telephone Number	:	386-454-2724

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/17/2016

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Directions to “P JOHN KIM MD ” Practice Location

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