Basic Information
| Provider Information | |||||||||
| NPI: | 1003045097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | ELIJAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871100 | ||||||||
| FaxNumber: | 8636306528 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871321 | ||||||||
| FaxNumber: | 8632841786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2009 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | ME152670 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208600000X | 52389 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036-143764 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 036-143764 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 52389 | TN | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 87843 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0127X | 036-143764 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | ME152670 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.