Provider Demographics
NPI:1649460437
Name:JK INTERNAL MEDICINE & GERIATRICS,PC
Entity type:Organization
Organization Name:JK INTERNAL MEDICINE & GERIATRICS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JINAHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-417-1255
Mailing Address - Street 1:1325 SATELLITE BLVD, BLDG 700 STE 701A
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4651
Mailing Address - Country:US
Mailing Address - Phone:678-417-1255
Mailing Address - Fax:678-417-1258
Practice Address - Street 1:1325 SATELLITE BLVD
Practice Address - Street 2:BLDG 700 STE 701A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4651
Practice Address - Country:US
Practice Address - Phone:678-417-1255
Practice Address - Fax:678-417-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59806207Q00000X
GA54442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA488455065AMedicaid
GA488455065AMedicaid
GAH61628Medicare UPIN