MEDICARE: DAVENPORT PEDIATRICS P D

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1205763158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVENPORT PEDIATRICS P D

Provider Business Mailing Address
First Line	:	113 SW 5TH CT,
Second Line	:	APT 1
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-3589
Country	:	US
Telephone Number	:	270-807-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SW 5TH CT
Second Line	:	APT 1
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-3589
Country	:	US
Telephone Number	:	270-807-8431
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MIN SOO JANG
Credential	:
Telephone Number	:	270-807-8431

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/25/2026

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Directions to “DAVENPORT PEDIATRICS P D ” Practice Location

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