Provider Demographics
NPI:1205861648
Name:KIM, JONG-HYUN (MD)
Entity type:Individual
Prefix:
First Name:JONG-HYUN
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 1:2550 PLEASANT HILL RD STE 126
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-9278
Mailing Address - Country:US
Mailing Address - Phone:770-622-1730
Mailing Address - Fax:770-622-1772
Practice Address - Street 1:2550 PLEASANT HILL RD STE 126
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-9278
Practice Address - Country:US
Practice Address - Phone:770-622-1730
Practice Address - Fax:770-622-1772
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA938829265AMedicaid
GA938829265AMedicaid
GA08CBBDCMedicare ID - Type Unspecified