Provider Demographics
NPI:1558823922
Name:KIM, NATHAN SUNG IN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SUNG IN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:790 DUNLAWTON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4222
Mailing Address - Country:US
Mailing Address - Phone:386-760-1877
Mailing Address - Fax:386-760-2791
Practice Address - Street 1:790 DUNLAWTON AVE STE E
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4222
Practice Address - Country:US
Practice Address - Phone:386-760-1877
Practice Address - Fax:386-760-2791
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME148046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine