Provider Demographics
NPI:1750411583
Name:KIM HONG, SOOJEONG (RPH)
Entity type:Individual
Prefix:MRS
First Name:SOOJEONG
Middle Name:
Last Name:KIM HONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GWINNETT PLACE DR STE 15
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4751
Mailing Address - Country:US
Mailing Address - Phone:770-837-0571
Mailing Address - Fax:
Practice Address - Street 1:3500 GWINNETT PLACE DR STE 15
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4751
Practice Address - Country:US
Practice Address - Phone:770-837-0571
Practice Address - Fax:770-837-0571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40390183500000X
GARPH025562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003168271AMedicaid