Kirsten Kim MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KIRSTEN KIM MD PA

Practice address

870 Dunlawton Ave Ste 311
Port Orange, FL 32127-9274

Phone

(386) 310-4807

Fax

(386) 310-7473

NPI assigned

Jul 1, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirsten Kim, MD

Title

Owner

Phone

(386) 310-4807

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1124699095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 DUNLAWTON AVE STE 311",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279274",
            "telephone_number": "386-310-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 DUNLAWTON AVE STE 311",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279274",
            "telephone_number": "386-310-4807",
            "fax_number": "386-310-7473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRSTEN KIM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-310-4807",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Marie King, LCSWC
• Gregory T Kipp, O.D.
• Pamela Kirby, D.P.M.
• Melanie Kirkman, M.S.
• Jessica Kirsch
• Ashley Kissam
• Daniel Anthony Klimek, DC
• Margaret Klintworth
• Laura Knepple
• Alejandro Knight, CRNA

• Family Medicine Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.