Kim, Jeffrey Mark

Kim, Jeffrey Mark is an sole proprietor health care provider with primary practice located at 4570 S Clyde Morris Blvd Suite 1, Port Orange FL 32129-5401. He recently has only one registered license in Dental Providers / Periodontics, which is considered as his primary health care specialty. Kim, Jeffrey Mark can be contacted via phone (386) 322-4867.

Contact Information

Primary practice address
4570 S Clyde Morris Blvd Suite 1 Port Orange FL 32129-5401
Phone: (386) 322-4867
Fax: (386) 322-3899
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Periodontics 1223P0300X DN13917 Florida

Profile Details

NPI number 1982974135
LBN Legal business name Kim, Jeffrey Mark
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 5th, 2012
Last updated Jan 5th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982974135 NPPES
Florida Other DN13917 STATE LICENSE NUMBER

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