Healthcare Provider Details

I. General information

NPI: 1235683335
Provider Name (Legal Business Name): KIM EMIKO ONO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 MERIDIAN MARK RD STE 180
ATLANTA GA
30342-3112
US

IV. Provider business mailing address

4532 CLUB CIR NE
ATLANTA GA
30319-1054
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3974
  • Fax:
Mailing address:
  • Phone: 404-785-3874
  • Fax: 494-785-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberPSY004030
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY004030
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: