Provider Demographics
NPI:1568469591
Name:KIM, KUN ZOO (MD)
Entity Type:Individual
Prefix:DR
First Name:KUN
Middle Name:ZOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3042 OAKCLIFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2699
Mailing Address - Country:US
Mailing Address - Phone:770-458-4255
Mailing Address - Fax:770-458-4406
Practice Address - Street 1:3042 OAKCLIFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2699
Practice Address - Country:US
Practice Address - Phone:770-458-4255
Practice Address - Fax:770-458-4406
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039608207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0683598OtherCIGNA
GA516833OtherAETNA
GA52498637OtherBCBS OF GEORGIA
GA000670458FMedicaid
GAG11658Medicare UPIN
GA52498637OtherBCBS OF GEORGIA