Provider Demographics
NPI:1033791017
Name:KIM, JOON HYUNG (DPM)
Entity type:Individual
Prefix:
First Name:JOON HYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18104 NW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3267
Mailing Address - Country:US
Mailing Address - Phone:352-262-7073
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD STE 470
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2842
Practice Address - Country:US
Practice Address - Phone:305-695-7777
Practice Address - Fax:305-850-6983
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty