Provider Demographics
NPI:1225625825
Name:KIM, JEANHIE FRANCES
Entity Type:Individual
Prefix:DR
First Name:JEANHIE
Middle Name:FRANCES
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 BARRETT LAKES BLVD NW APT 1122
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-8005
Mailing Address - Country:US
Mailing Address - Phone:678-200-7840
Mailing Address - Fax:
Practice Address - Street 1:6095 PINE MOUNTAIN RD NW STE 108
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3332
Practice Address - Country:US
Practice Address - Phone:770-421-1399
Practice Address - Fax:866-635-2329
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist