Provider Demographics
NPI:1780767632
Name:KIM, YONGDONG (PHARM D)
Entity type:Individual
Prefix:DR
First Name:YONGDONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 GEORGETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6623
Mailing Address - Country:US
Mailing Address - Phone:770-688-9442
Mailing Address - Fax:
Practice Address - Street 1:2550 PLEASANT HILL RD STE 126
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-9278
Practice Address - Country:US
Practice Address - Phone:770-622-0688
Practice Address - Fax:770-622-0689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0039689183500000X
GARPH025519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050447Medicare ID - Type Unspecified