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Provider Information for 1366400590

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MICHAEL KWANGSOO KIM M.D.

Gender: MALE

Individual NPI: 1366400590

Calendar   Last Updated:  2011-05-11
  Certification Date: 

Details

Name Value
NPI 1366400590
Enumeration Date 2006-05-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3700 CENTRAL AVE STE 1
FORT MYERS, FL 33901-7649
United States

Phone: 239-939-5233 | Fax: 239-939-9225
View Map External Link
Primary Practice Address 3700 CENTRAL AVE STE 1
FORT MYERS, FL 33901-7649
United States

Phone: 239-939-5233 | Fax: 239-939-9225
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2086S0122X - Surgery Plastic and Reconstructive Surgery FL ME78833