Provider Demographics
NPI:1760473276
Name:KIM, KYOUNG-SOON (MD)
Entity Type:Individual
Prefix:DR
First Name:KYOUNG-SOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1770 DENNIS KEMP LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3938
Mailing Address - Country:US
Mailing Address - Phone:770-515-9000
Mailing Address - Fax:678-813-3355
Practice Address - Street 1:1770 DENNIS KEMP LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3938
Practice Address - Country:US
Practice Address - Phone:770-515-9000
Practice Address - Fax:678-813-3355
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039144208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics