Provider Demographics
NPI:1043410293
Name:KIM, SOOK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOOK
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 PLEASANT HILL RD
Mailing Address - Street 2:# 140
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2326
Mailing Address - Country:US
Mailing Address - Phone:678-924-9848
Mailing Address - Fax:678-924-9819
Practice Address - Street 1:1625 PLEASANT HILL RD
Practice Address - Street 2:# 140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2326
Practice Address - Country:US
Practice Address - Phone:678-924-9848
Practice Address - Fax:678-924-9819
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN 013790122300000X
FLDN18400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002879200Medicaid