Healthcare Provider Details

I. General information

NPI: 1790341691
Provider Name (Legal Business Name): DAVID KIM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 BROOKSIDE PKWY STE 300
ALPHARETTA GA
30022-4458
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1911
  • Fax: 770-442-0306
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9515
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: