MEDICARE: EMILY MIMI KANG

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	207R00000X	Internal Medicine Physician	79636	GA

General Provider Information

NPI Number	:	1750763173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MIMI KANG

Provider Business Mailing Address
First Line	:	4855 RIVER GREEN PKWY STE 140
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8333
Country	:	US
Telephone Number	:	678-417-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 RIVER GREEN PKWY STE 140
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8333
Country	:	US
Telephone Number	:	678-417-0077
Fax Number	:

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/19/2025

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