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General NPI Number Information
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NPI Number | 1003352857
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Entity Type | Organization
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Legal Business Name | KIMCHANG & COMPANY, LLC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 2155 POST OAK TRITT RD STE 450
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City | MARIETTA
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State | GA
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Zip | 30062-8608
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Country | US
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Telephone | 770-971-5536
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Fax | 770-971-3046
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Provider Business Mailing Address
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Address Line | 2155 POST OAK TRITT RD STE 450
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City | MARIETTA
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State | GA
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Zip | 30062-8608
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Country | US
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Telephone | 770-971-5536
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Fax | 770-971-3046
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SEUNGBUM KIM
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Credential |
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Telephone | 404-900-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013629
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License Number State | GA
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