Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME134715 | FL |
NPI | 1225444664 |
---|---|
Provider Name | Jun Ho Kim |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 26/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100263900 | (05) | FL |