Healthcare Provider Details

I. General information

NPI: 1265648539
Provider Name (Legal Business Name): JUNG BUM KIM D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 VENTURE DR BLDG N STE 101
DULUTH GA
30096-5102
US

IV. Provider business mailing address

3775 VENTURE DR STE 101
DULUTH GA
30096-5102
US

V. Phone/Fax

Practice location:
  • Phone: 770-817-9608
  • Fax: 770-817-9610
Mailing address:
  • Phone: 770-817-9608
  • Fax: 770-817-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLIC562
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7922
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: