| Provider / Organization | NPI | Date Certified |
|---|---|---|
| PAUL KIM | 1770112898 | 2020-04-02 |
Paul Kim is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1770112898. Registration indicates Paul Kim is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Paul Kim |
| Practice Office Address | 9330 STATE ROAD 54 TRINITY, FL US |
| Practice Office Telephone | 7278344832 |
| Practice Office Fax | 7278162463 |
| Mailing Address | 9330 STATE ROAD 54 TRINITY, FL 346551808 US |
| Business Telephone | 7278344832 |
| Business Fax | 7278162463 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 9330 State Road 54 | Trinity, FL 346551808 | 7278344832 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |