Provider Demographics
NPI:1609411941
Name:KIM, CHERRY (MACOM, AP)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MACOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7608
Mailing Address - Country:US
Mailing Address - Phone:407-308-5001
Mailing Address - Fax:
Practice Address - Street 1:3722 CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7608
Practice Address - Country:US
Practice Address - Phone:407-504-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4081171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist