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NPI Code Detail

MEDICARE: MR. DONG JIN KIM

MEDICARE: MR. DONG JIN KIM
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
1183500000XPharmacistPS41788FL

General Provider Information

NPI Number : 1518358316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONG JIN KIM
Provider Business Mailing Address
First Line : 195 E HARTFORD ST APT 7A
Second Line :
City : HERNANDO
State : FL
Zip : 34442-3390
Country : US
Telephone Number : 352-419-0220
Fax Number :
Provider Business Practice Location Address
First Line : 1651 SE US HIGHWAY 19
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-4830
Country : US
Telephone Number : 352-794-0089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2015
Last Update Date : 02/15/2015

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