Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME131161 | FL |
NPI | 1053677260 |
---|---|
Provider Name | So Dam Kim |
First Address | Gainesville, FL 32611-2700 |
Second Address | Gainesville, FL 32610-3411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 26/10/2017 |