Healthcare Provider Details

I. General information

NPI: 1184301822
Provider Name (Legal Business Name): DR. SEUNGEON KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 14TH ST
COLUMBUS GA
31901-3857
US

IV. Provider business mailing address

6400 MAIN ST APT 17E
COLUMBUS GA
31909-3593
US

V. Phone/Fax

Practice location:
  • Phone: 706-920-3498
  • Fax:
Mailing address:
  • Phone: 917-912-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: