Provider Demographics
NPI:1952587230
Name:YOCK KIM, ROLAND (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:
Last Name:YOCK KIM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3920
Mailing Address - Country:US
Mailing Address - Phone:786-282-0811
Mailing Address - Fax:305-383-8877
Practice Address - Street 1:8352 SW 146TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3920
Practice Address - Country:US
Practice Address - Phone:786-282-0811
Practice Address - Fax:305-383-8877
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM38334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist