Provider Demographics
NPI:1831245034
Name:KIM, MEEKYUNG M (MD)
Entity type:Individual
Prefix:DR
First Name:MEEKYUNG
Middle Name:M
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FERRY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-778-6100
Mailing Address - Fax:404-778-6160
Practice Address - Street 1:875 JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-778-6100
Practice Address - Fax:404-778-6160
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG43469Medicare UPIN
GA11BDWSKMedicare ID - Type Unspecified