Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME143884 | FL |
Y | 207RX0202X | Medical Oncology | ME143884 | FL |
NPI | 1316109994 |
---|---|
Provider Name | Hyon Jeong Kim |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Tampa, FL 33607-6214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 13/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105929300 | (05) | FL |