Provider Demographics
NPI:1003410606
Name:KANG KIM, YEO WHOA
Entity Type:Individual
Prefix:
First Name:YEO WHOA
Middle Name:
Last Name:KANG KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 WHITEWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5480
Mailing Address - Country:US
Mailing Address - Phone:904-252-2702
Mailing Address - Fax:
Practice Address - Street 1:12804 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5801
Practice Address - Country:US
Practice Address - Phone:352-567-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist