Provider Demographics
NPI:1194732750
Name:KIM, KEITH CHAE (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:CHAE
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-303-4658
Mailing Address - Fax:407-303-4189
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 401
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-303-4658
Practice Address - Fax:407-303-4189
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-04-30
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Provider Licenses
StateLicense IDTaxonomies
FLME88949208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH01199Medicare UPIN