Provider Demographics
NPI:1275540932
Name:KIM, HEE-JUN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:HEE-JUN
Middle Name:GREGORY
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W BARNARD ST
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-9677
Mailing Address - Country:US
Mailing Address - Phone:912-654-2460
Mailing Address - Fax:912-654-1457
Practice Address - Street 1:706 W BARNARD ST
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427
Practice Address - Country:US
Practice Address - Phone:912-654-2460
Practice Address - Fax:912-654-1457
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26317208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D70508Medicare UPIN