Provider Demographics
NPI:1851487292
Name:KIM, URIAN (MD)
Entity Type:Individual
Prefix:
First Name:URIAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1100 SAWGRASS VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-3083
Practice Address - Country:US
Practice Address - Phone:904-285-9355
Practice Address - Fax:904-285-7474
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07864200208000000X
FLME125625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics