Healthcare Provider Details

I. General information

NPI: 1639093263
Provider Name (Legal Business Name): LIA KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 BUFORD HWY NE STE 202
DORAVILLE GA
30340-1168
US

IV. Provider business mailing address

1224 OLD PEACHTREE RD NE UNIT 4318
LAWRENCEVILLE GA
30043-1117
US

V. Phone/Fax

Practice location:
  • Phone: 770-451-7848
  • Fax:
Mailing address:
  • Phone: 714-581-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: