Provider Demographics
NPI:1700291945
Name:KIM, BRYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 HILLTOP OVERLOOK WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2915
Mailing Address - Country:US
Mailing Address - Phone:248-390-4129
Mailing Address - Fax:
Practice Address - Street 1:3345 COBB PKWY NW STE 800
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8346
Practice Address - Country:US
Practice Address - Phone:678-919-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80126207P00000X
MI5101021148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine