Healthcare Provider Details

I. General information

NPI: 1821153271
Provider Name (Legal Business Name): JOSHUAH SUNGGON KIM L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUAH SUNGGON KIM L.AC.

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 MALL BLVD STE 7D
DULUTH GA
30096-4727
US

IV. Provider business mailing address

3525 MALL BLVD STE 7D
DULUTH GA
30096-4727
US

V. Phone/Fax

Practice location:
  • Phone: 470-417-4888
  • Fax:
Mailing address:
  • Phone: 470-417-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number598
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number283
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0283
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: