Provider Demographics
NPI:1821017799
Name:KIM, RAY HYO IL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:HYO IL
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278587
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-8587
Mailing Address - Country:US
Mailing Address - Phone:305-596-5355
Mailing Address - Fax:954-435-8809
Practice Address - Street 1:9055 SW 87TH AVE
Practice Address - Street 2:STE 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2306
Practice Address - Country:US
Practice Address - Phone:305-596-5355
Practice Address - Fax:954-435-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2860213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4920Medicare ID - Type Unspecified
FLU82917Medicare UPIN