Healthcare Provider Details

I. General information

NPI: 1447912803
Provider Name (Legal Business Name): KIM'S ACUPUNCTURE AND CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BOGGS RD STE 106
DULUTH GA
30096-4602
US

IV. Provider business mailing address

2005 BOGGS RD STE 106
DULUTH GA
30096-4602
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-0882
  • Fax: 770-497-0861
Mailing address:
  • Phone: 770-497-0882
  • Fax: 770-497-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: SOON A KIM
Title or Position: CEO
Credential:
Phone: 770-497-0882