Provider Demographics
NPI:1114155702
Name:KIM, JINA Y (MD)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4843
Mailing Address - Country:US
Mailing Address - Phone:678-417-0332
Mailing Address - Fax:678-417-0313
Practice Address - Street 1:3610 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4843
Practice Address - Country:US
Practice Address - Phone:678-417-0332
Practice Address - Fax:678-417-0313
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068656207Q00000X
SCMD31877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine