Provider Demographics
NPI:1689813149
Name:KIM, SOON AE (DC, L AC)
Entity Type:Individual
Prefix:
First Name:SOON
Middle Name:AE
Last Name:KIM
Suffix:
Gender:F
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HORIZON PARK DRIVE
Mailing Address - Street 2:SUITE
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 HORIZON PARK DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-221-7466
Practice Address - Fax:770-676-6592
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000240171100000X
GA006569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist