Provider Demographics
NPI:1306849732
Name:KIM, SOYUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:SOYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 HABERSHAM RD. SUITE 109
Mailing Address - Street 2:FAMILY EYE CARE CENTER OF ATLANTA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:713-743-1921
Mailing Address - Fax:713-743-0963
Practice Address - Street 1:3645 HABERSHAM RD. SUITE 109
Practice Address - Street 2:FAMILY EYE CARE CENTER OF ATLANTA
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-549-9999
Practice Address - Fax:713-743-0963
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1666760-01Medicaid
TXU92855Medicare UPIN
TX8A1741Medicare ID - Type Unspecified