Provider Demographics
NPI:1629181136
Name:JOON Y. KIM, MD, PC
Entity Type:Organization
Organization Name:JOON Y. KIM, MD, PC
Other - Org Name:CLAYTON CATARACT & LASER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-968-8888
Mailing Address - Street 1:1000 CORPORATE CENTER DR
Mailing Address - Street 2:STE 180
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4180
Mailing Address - Country:US
Mailing Address - Phone:770-968-8888
Mailing Address - Fax:770-960-2473
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:STE 180
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4180
Practice Address - Country:US
Practice Address - Phone:770-968-8888
Practice Address - Fax:770-960-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031147261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490003651OtherRAILROAD MEDICARE
GA000783802AMedicaid
490003651OtherRAILROAD MEDICARE