| J. Kim Periodontics, Llc | |
|
4570 S Clyde Morris Blvd Suite 1 Port Orange FL 32129-5401 | |
| (386) 322-4867 | |
| Not Available |
| Full Name | J. Kim Periodontics, Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 4570 S Clyde Morris Blvd, Port Orange, Florida |
| Authorized Official Name and Position | Jeffrey M Kim (OWNER) |
| Authorized Official Contact | 3863224867 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Kim Periodontics, Llc 4570 S Clyde Morris Blvd Suite 1 Port Orange FL 32129-5401 Ph: (386) 322-4867 | J. Kim Periodontics, Llc 4570 S Clyde Morris Blvd Suite 1 Port Orange FL 32129-5401 Ph: (386) 322-4867 |
| NPI Number | 1629198551 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 09/28/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629198551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | DN13917 (Florida) | Primary |
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