Provider Demographics
NPI:1336386598
Name:KIM ENT, P.C.
Entity Type:Organization
Organization Name:KIM ENT, P.C.
Other - Org Name:KIM ENT & FACIAL PLASTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-458-4255
Mailing Address - Street 1:3042 OAKCLIFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2699
Mailing Address - Country:US
Mailing Address - Phone:770-458-4255
Mailing Address - Fax:770-458-4406
Practice Address - Street 1:3042 OAKCLIFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2699
Practice Address - Country:US
Practice Address - Phone:770-458-4255
Practice Address - Fax:770-458-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039608284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital