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10205 W Hillsborough Ave Tampa FL 33615-3671 | |
| (813) 884-2300 | |
| (813) 884-2390 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 10205 W Hillsborough Ave, Tampa, Florida |
| Authorized Official Name and Position | Jun H Kim (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 8138842300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10205 W Hillsborough Ave Tampa FL 33615-3671 Ph: (813) 884-2300 | 10205 W Hillsborough Ave Tampa FL 33615-3671 Ph: (813) 884-2300 |
| NPI Number | 1699875096 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 09/13/2019 |
| Medicare PECOS PAC ID | 1658501796 |
|---|---|
| Medicare Enrollment ID | O20140311000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699875096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jin M Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871693267 PECOS PAC ID: 4284673930 Enrollment ID: I20050502000818 |
| Provider Name | Gregory O Jefferson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174602031 PECOS PAC ID: 0446419501 Enrollment ID: I20120308000372 |
| Provider Name | Lorie Lee Nguyen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356658447 PECOS PAC ID: 5092956771 Enrollment ID: I20130723000063 |
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