Healthcare Provider Details

I. General information

NPI: 1558285189
Provider Name (Legal Business Name): HYOUN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE KIM

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 ABBOTTS BRIDGE RD STE 302
JOHNS CREEK GA
30097-1750
US

IV. Provider business mailing address

4854 STRATFORD LN
JOHNS CREEK GA
30022-2503
US

V. Phone/Fax

Practice location:
  • Phone: 770-233-7494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN253104
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: