Provider Demographics
NPI:1073546024
Name:KIM, JUN H (PA-C)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:404-351-5045
Mailing Address - Fax:404-974-2196
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-351-5045
Practice Address - Fax:404-974-2196
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA5002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIQ66707Medicare UPIN
VI0057729Medicare ID - Type Unspecified