Provider Demographics
NPI:1861483166
Name:KIM, BRIAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3840 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8108
Practice Address - Country:US
Practice Address - Phone:239-275-6400
Practice Address - Fax:239-275-0178
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66697207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375598300Medicaid
FL830004833OtherRR MEDICARE
FL25728VMedicare PIN
FL375598300Medicaid