Provider Demographics
NPI:1518003771
Name:KIM, TONI JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:JEANNE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2870 PEACHTREE RD NW # 894
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2918
Mailing Address - Country:US
Mailing Address - Phone:678-956-0005
Mailing Address - Fax:770-702-0998
Practice Address - Street 1:8601 DUNWOODY PL STE 565
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2516
Practice Address - Country:US
Practice Address - Phone:678-956-0005
Practice Address - Fax:770-702-0998
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN80222080P0205X
NY2325942080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03135348Medicaid
TX280064101Medicaid