Provider Demographics
NPI:1407192479
Name:KIM, WANG HEE
Entity Type:Individual
Prefix:MR
First Name:WANG HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 LANDTREE PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5952
Mailing Address - Country:US
Mailing Address - Phone:516-302-3199
Mailing Address - Fax:407-203-3531
Practice Address - Street 1:2916 LANDTREE PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-5952
Practice Address - Country:US
Practice Address - Phone:516-302-3199
Practice Address - Fax:407-203-3531
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00103800171100000X
NY004685171100000X
NY021639225700000X
FLMA-90771225700000X
FLAP-3997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist