Provider Demographics
NPI:1992865497
Name:KIM, JIN HO (DOM, AP, LAC, PDD)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DOM, AP, LAC, PDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MANGOUSTINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1098
Mailing Address - Country:US
Mailing Address - Phone:407-593-9350
Mailing Address - Fax:497-539-2661
Practice Address - Street 1:321 N MANGOUSTINE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1098
Practice Address - Country:US
Practice Address - Phone:407-539-3950
Practice Address - Fax:407-539-2661
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12749100Medicaid