Provider Demographics
NPI:1871693267
Name:KIM, JIN M (DO)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:M
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3671
Mailing Address - Country:US
Mailing Address - Phone:813-884-2300
Mailing Address - Fax:813-884-2390
Practice Address - Street 1:10205 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3671
Practice Address - Country:US
Practice Address - Phone:813-884-2300
Practice Address - Fax:813-884-2390
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49378YMedicare PIN
FLH18853Medicare UPIN