Provider Demographics
NPI:1932466174
Name:LOMA CLINIC
Entity Type:Organization
Organization Name:LOMA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOOYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-696-7456
Mailing Address - Street 1:3705 OLD NORCROSS RD
Mailing Address - Street 2:#400
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4335
Mailing Address - Country:US
Mailing Address - Phone:770-476-7676
Mailing Address - Fax:770-476-7679
Practice Address - Street 1:3705 OLD NORCROSS RD
Practice Address - Street 2:#400
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4335
Practice Address - Country:US
Practice Address - Phone:770-476-7676
Practice Address - Fax:770-476-7679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOMA CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008481111N00000X
GA236171100000X
GA05421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty