Healthcare Provider Details

I. General information

NPI: 1417110784
Provider Name (Legal Business Name): HYEONG JOONG KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1550
ATLANTA GA
30308-2253
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1550
ATLANTA GA
30308-2253
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-2505
  • Fax: 404-686-4840
Mailing address:
  • Phone: 404-686-2505
  • Fax: 404-686-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number102780
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number102780
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number102780
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number102780
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: