Provider Demographics
NPI:1366411514
Name:KIM, LANCE Y (DO)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7751
Mailing Address - Country:US
Mailing Address - Phone:352-867-9877
Mailing Address - Fax:352-867-1040
Practice Address - Street 1:2237 SW 19TH AVENUE RD STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7751
Practice Address - Country:US
Practice Address - Phone:352-867-9877
Practice Address - Fax:352-291-5096
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS74482084V0102X, 2084N0400X, 2084P2900X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272016700Medicaid
FL56743ZMedicare ID - Type Unspecified
G69772Medicare UPIN