Organization
J. KIM PERIODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY M KIM DDS (OWNER)
(386) 322-4867
Entity
Organization
Contact information
Practice address
4570 S CLYDE MORRIS BLVD, SUITE 1, PORT ORANGE, FL 32129-5401
(386) 322-4867
Mailing address
4570 S CLYDE MORRIS BLVD, SUITE 1, PORT ORANGE, FL 32129-5401
(386) 322-4867
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN13917
FL
Other
Enumeration date
04/02/2007
Last updated
09/28/2007
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