Provider Demographics
NPI:1992844864
Name:KIM, DOOHO BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOOHO
Middle Name:BRIAN
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 1:1111 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2588
Mailing Address - Country:US
Mailing Address - Phone:705-226-2020
Mailing Address - Fax:706-217-2876
Practice Address - Street 1:1111 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2588
Practice Address - Country:US
Practice Address - Phone:705-226-2020
Practice Address - Fax:706-217-2876
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058533207W00000X
LAMD026175207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA587823919AMedicaid
GA587823919AMedicaid