Provider Demographics
NPI:1821246729
Name:KIM, JOSEPH (DDS, DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BOGGS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4602
Mailing Address - Country:US
Mailing Address - Phone:770-497-0885
Mailing Address - Fax:770-497-0861
Practice Address - Street 1:2005 BOGGS RD STE 104
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4602
Practice Address - Country:US
Practice Address - Phone:770-497-0882
Practice Address - Fax:770-497-0861
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005434111N00000X
GADN0137661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU66556Medicare UPIN
GA35ZCDSKMedicare PIN