Provider Demographics
NPI:1295473015
Name:CASE, MIN-YOUNG KIM (DMD)
Entity type:Individual
Prefix:DR
First Name:MIN-YOUNG
Middle Name:KIM
Last Name:CASE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:MIN-YOUNG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 RALPH MCGILL BLVD NE APT 2607
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1156
Mailing Address - Country:US
Mailing Address - Phone:803-389-8514
Mailing Address - Fax:
Practice Address - Street 1:3590 BRASELTON HWY STE 100
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1117
Practice Address - Country:US
Practice Address - Phone:770-448-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1236191223X0400X, 122300000X
OHRES.004524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist