Healthcare Provider Details

I. General information

NPI: 1952529018
Provider Name (Legal Business Name): JONG KYU KIM, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 OLD PEACHTREE RD NW STE 423
SUWANEE GA
30024-2033
US

IV. Provider business mailing address

1291 OLD PEACHTREE RD NW STE 423
SUWANEE GA
30024-2033
US

V. Phone/Fax

Practice location:
  • Phone: 770-945-9035
  • Fax: 770-814-9277
Mailing address:
  • Phone: 770-945-9035
  • Fax: 770-814-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JONG KYU KIM
Title or Position: DIRECTOR
Credential: D.C.
Phone: 770-945-9035