Healthcare Provider Details

I. General information

NPI: 1538075262
Provider Name (Legal Business Name): MIN SOO KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 PEACHTREE INDUSTRIAL BLVD STE 300
DULUTH GA
30096-5139
US

IV. Provider business mailing address

3610 PEACHTREE INDUSTRIAL BLVD STE 300
DULUTH GA
30096-5139
US

V. Phone/Fax

Practice location:
  • Phone: 678-731-7043
  • Fax:
Mailing address:
  • Phone: 678-731-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: