Provider Demographics
NPI:1558823922
Name:KIM, NATHAN SUNG IN (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SUNG IN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1590 S STATE ROAD 15A STE 100
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7817
Mailing Address - Country:US
Mailing Address - Phone:386-774-0016
Mailing Address - Fax:386-774-0606
Practice Address - Street 1:1590 S STATE ROAD 15A STE 100
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7817
Practice Address - Country:US
Practice Address - Phone:386-774-0016
Practice Address - Fax:386-774-0606
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine