Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | C51880 | CA |
NPI | 1023032901 |
---|---|
Provider Name | Dr. Inwon Kim |
First Address | Bartow, FL 33830-6740 |
Second Address | Lake Wales, FL 33853-4024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 30/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
280870600 | (05) | FL |
D31998 | (02) | CA |