Healthcare Provider Details

I. General information

NPI: 1063360717
Provider Name (Legal Business Name): YJ KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S JEFFERSON ST
MONTICELLO FL
32344-1635
US

IV. Provider business mailing address

1301 S JEFFERSON ST
MONTICELLO FL
32344-1635
US

V. Phone/Fax

Practice location:
  • Phone: 470-331-0840
  • Fax:
Mailing address:
  • Phone: 470-331-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO66625
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: