Provider Demographics
NPI:1871763235
Name:KIM, DENNIS H (MD)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33920 US HIGHWAY 19N SUITE 341
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-787-6744
Mailing Address - Fax:727-786-3561
Practice Address - Street 1:33920 US HIGHWAY 19N SUITE 341
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-787-6744
Practice Address - Fax:727-786-3561
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101331207K00000X
FL101331207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024927400Medicaid