Provider Demographics
NPI:1780946251
Name:KIM, JEE-EUN (DMD)
Entity type:Individual
Prefix:DR
First Name:JEE-EUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 PEACHTREE PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9101
Mailing Address - Country:US
Mailing Address - Phone:678-408-2121
Mailing Address - Fax:678-408-2121
Practice Address - Street 1:3495 PEACHTREE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9101
Practice Address - Country:US
Practice Address - Phone:678-408-2121
Practice Address - Fax:678-408-2121
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty