Healthcare Provider Details

I. General information

NPI: 1295437895
Provider Name (Legal Business Name): SEO HYUN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 TRAMMEL RD STE 400
CUMMING GA
30041-1335
US

IV. Provider business mailing address

2735 MCGINNIS FERRY RD UNIT 3301
SUWANEE GA
30024-5815
US

V. Phone/Fax

Practice location:
  • Phone: 678-879-3006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN124309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: