Provider Demographics
NPI:1922057702
Name:KIM, JINAHN (MD)
Entity Type:Individual
Prefix:MR
First Name:JINAHN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SATELLITE BLVD.
Mailing Address - Street 2:BLDG. 700, STE 701A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4651
Mailing Address - Country:US
Mailing Address - Phone:678-417-1255
Mailing Address - Fax:678-417-1258
Practice Address - Street 1:1325 SATELLITE BLVD.
Practice Address - Street 2:BLDG. 700, STE 701A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4651
Practice Address - Country:US
Practice Address - Phone:678-417-1255
Practice Address - Fax:678-417-1258
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
511I110297OtherMEDICARE PTAN
GA921315018AMedicaid
11SCFHJMedicare ID - Type Unspecified
GA921315018AMedicaid