MEDICARE: DR. 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	ME0045274	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080010562	OTHER		RAILROAD MEDICARE

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	:	1669472098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/24/2017

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Directions to “ DR. P JOHN KIM MD” Practice Location

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