Healthcare Provider Details

I. General information

NPI: 1922630839
Provider Name (Legal Business Name): DAVID HYUN WOO KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SANDY SPRINGS PL
SANDY SPRINGS GA
30328-5918
US

IV. Provider business mailing address

227 SANDY SPRINGS PL
SANDY SPRINGS GA
30328-5918
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2779
  • Fax:
Mailing address:
  • Phone: 404-256-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number029979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: