Provider Demographics
NPI:1720295421
Name:KIM, HYUNG BONG (AP)
Entity type:Individual
Prefix:MR
First Name:HYUNG BONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:AP
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:H B
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AP
Mailing Address - Street 1:13354 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4860
Mailing Address - Country:US
Mailing Address - Phone:352-597-0584
Mailing Address - Fax:352-597-5273
Practice Address - Street 1:5310 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4557
Practice Address - Country:US
Practice Address - Phone:352-688-8088
Practice Address - Fax:352-684-7300
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL354171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist