Healthcare Provider Details

I. General information

NPI: 1033404066
Provider Name (Legal Business Name): JOHN D. KIM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 OLD PEACHTREE RD NW SUITE # 101
SUWANEE GA
30024-2028
US

IV. Provider business mailing address

1299 OLD PEACHTREE RD NW SUITE # 101
SUWANEE GA
30024-2028
US

V. Phone/Fax

Practice location:
  • Phone: 770-882-6666
  • Fax: 770-252-6800
Mailing address:
  • Phone: 770-882-6666
  • Fax: 770-252-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR008162
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008162
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCHIR008162
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberCHIR008162
License Number StateGA

VIII. Authorized Official

Name: DR. DO YOUNG KIM
Title or Position: OWNER
Credential: D.C.
Phone: 770-882-6666