Provider Demographics
NPI:1881007797
Name:KIM, CHOON K (LDO)
Entity type:Individual
Prefix:
First Name:CHOON
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 SATELLITE BLVD.
Mailing Address - Street 2:#200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-473-0911
Mailing Address - Fax:678-473-9100
Practice Address - Street 1:3751 SATELLITE BLVD
Practice Address - Street 2:#200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8840
Practice Address - Country:US
Practice Address - Phone:678-473-0911
Practice Address - Fax:678-473-9100
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001889156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician