JEFFREY MARK KIM DDS NPI 1982974135

NPI Information

NPI: 1982974135
Provider Name: JEFFREY MARK KIM, DDS
Classification: Dentist - 1223P0300X
Entity Type: Individual

Specialization: Periodontics

PECOS Registration: Yes

Address:
4570 S CLYDE MORRIS BLVD
SUITE 1
PORT ORANGE, FL
ZIP 32129
Phone: (386) 322-4867
Get Directions

Jeffrey Mark Kim, DDS is a periodontics dentist in Port Orange, FL. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. Jeffrey Mark Kim, DDS NPI is 1982974135. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4570 S CLYDE MORRIS BLVD
SUITE 1
PORT ORANGE, FL
ZIP 32129-401
Phone: (386) 322-4867
Fax: (386) 322-3899

The NPI 1982974135 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 1/5/2012 and was last updated on 1/5/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0300X	Dentist	Periodontics	DN13917	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	DN13917	OTHER	FLORIDA	STATE LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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