Provider Demographics
NPI:1750167615
Name:KIM, HYONWOO ADAM (CPO)
Entity type:Individual
Prefix:MR
First Name:HYONWOO
Middle Name:ADAM
Last Name:KIM
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPO
Mailing Address - Street 1:115 S MACDILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3128
Mailing Address - Country:US
Mailing Address - Phone:813-251-1590
Mailing Address - Fax:
Practice Address - Street 1:115 S MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3128
Practice Address - Country:US
Practice Address - Phone:813-251-1590
Practice Address - Fax:813-251-0642
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR243224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist