Provider Demographics
NPI:1811171960
Name:KIM, JIWON (OMD)
Entity type:Individual
Prefix:DR
First Name:JIWON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD
Mailing Address - Street 1:5006 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2801
Mailing Address - Country:US
Mailing Address - Phone:239-961-0585
Mailing Address - Fax:
Practice Address - Street 1:5006 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2801
Practice Address - Country:US
Practice Address - Phone:239-304-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist