Provider Demographics
NPI:1508906132
Name:KIM, GEORGE GI-MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GI-MIN
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:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:NC
Mailing Address - Zip Code:28750-0219
Mailing Address - Country:US
Mailing Address - Phone:828-859-7659
Mailing Address - Fax:828-859-2470
Practice Address - Street 1:2536 LYNN RD
Practice Address - Street 2:SUITE B
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-7875
Practice Address - Country:US
Practice Address - Phone:828-859-7659
Practice Address - Fax:828-859-2470
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891061YMedicaid
NCP00243621OtherRAILROAD MEDICARE
NC1061YOtherBLUE CROSS BLUE SHIELD
SCN0061DMedicaid
2242002BMedicare PIN