Provider Demographics
NPI:1629592829
Name:KIM, KYUNG MIN (ATC)
Entity Type:Individual
Prefix:DR
First Name:KYUNG MIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 LEVANTE AVE # MO128
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2416
Mailing Address - Country:US
Mailing Address - Phone:305-284-6959
Mailing Address - Fax:305-284-4183
Practice Address - Street 1:1507 LEVANTE AVE # MO128
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2416
Practice Address - Country:US
Practice Address - Phone:305-284-6959
Practice Address - Fax:305-284-4183
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL43552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer