Provider Demographics
NPI:1508903030
Name:WOMENS SPECIAL CARE P A
Entity Type:Organization
Organization Name:WOMENS SPECIAL CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SUNWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM-ASHCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-858-1574
Mailing Address - Street 1:7803 HOLLYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7135
Mailing Address - Country:US
Mailing Address - Phone:904-858-1574
Mailing Address - Fax:904-398-4263
Practice Address - Street 1:3900 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4313
Practice Address - Country:US
Practice Address - Phone:904-858-1574
Practice Address - Fax:904-398-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77123207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261872900Medicaid
FLK2922Medicare ID - Type Unspecified
FL261872900Medicaid