Provider Demographics
NPI:1205128360
Name:KIM, JEUNG HYOUN (OD)
Entity type:Individual
Prefix:
First Name:JEUNG
Middle Name:HYOUN
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DAWSON VILLAGE WAY S
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-5632
Mailing Address - Country:US
Mailing Address - Phone:706-216-7732
Mailing Address - Fax:706-216-0168
Practice Address - Street 1:29 DAWSON VILLAGE WAY S
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5632
Practice Address - Country:US
Practice Address - Phone:706-216-7732
Practice Address - Fax:706-216-0168
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist