Healthcare Provider Details

I. General information

NPI: 1609762996
Provider Name (Legal Business Name): KATHERINE HUI-JIN KIM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BRIERGATE DR
DULUTH GA
30097-6242
US

IV. Provider business mailing address

1920 BRIERGATE DR
DULUTH GA
30097-6242
US

V. Phone/Fax

Practice location:
  • Phone: 770-891-6405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383888
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN09291
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN332331
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: