Provider Demographics
NPI:1265648539
Name:KIM, JUNG BUM (DC)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:BUM
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 PLEASANT HILL RD STE 124
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-9278
Mailing Address - Country:US
Mailing Address - Phone:770-814-7400
Mailing Address - Fax:
Practice Address - Street 1:2550 PLEASANT HILL RD STE 124
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-9278
Practice Address - Country:US
Practice Address - Phone:770-814-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor