MEDICARE: SEJONG KIM PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT008581	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619079845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEJONG KIM PT

Provider Business Mailing Address
First Line	:	1325 SATELLITE BLVD NW
Second Line	:	STE 1302
City	:	SUWANEE
State	:	GA
Zip	:	30024-4651
Country	:	US
Telephone Number	:	678-206-0808
Fax Number	:	678-206-0809

Provider Business Practice Location Address
First Line	:	1325 SATELLITE BLVD NW
Second Line	:	STE 1302
City	:	SUWANEE
State	:	GA
Zip	:	30024-4651
Country	:	US
Telephone Number	:	678-206-0808
Fax Number	:	678-206-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/15/2012

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Directions to “ SEJONG KIM PT” Practice Location

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