Provider Demographics
NPI:1275531907
Name:KIM, JENNY CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:CHRISTINE
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:NORTHSIDE HOSPITAL- MANAGED CARE DEPT
Mailing Address - Street 2:1000 JOHNSON FERRY RD
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-297-4230
Mailing Address - Fax:404-297-4252
Practice Address - Street 1:484 IRVIN CT
Practice Address - Street 2:STE 140
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5406
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:404-297-4252
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054440207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA862450770CMedicaid
GA862450770WMedicaid
GA862450770BMedicaid
GA862450770UMedicaid
GA862450770AMedicaid
GA862450770DMedicaid
GA862450770CMedicaid
GA862450770UMedicaid