Provider Demographics
NPI:1497856264
Name:KIM-LU, GRACE (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KIM-LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 S ALAFAYA TRL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8956
Mailing Address - Country:US
Mailing Address - Phone:407-249-1234
Mailing Address - Fax:407-249-1755
Practice Address - Street 1:1561 S ALAFAYA TRL
Practice Address - Street 2:SUITE 400
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8956
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:407-249-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204167208000000X
FLME128787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics