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General NPI Number Information
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NPI Number | 1033869268
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Entity Type | Individual
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Provider Name | JIHAE KIM
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Gender | Female
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1075 WHITLOCK AVE SW STE I
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City | MARIETTA
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State | GA
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Zip | 30064-1996
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Country | US
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Telephone | 404-435-0718
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Fax | 404-941-9543
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Provider Business Mailing Address
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Address Line | 5301 SOUTH CONGRESS AVE 3 SOUTH
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City | ATLANTIS
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State | FL
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Zip | 33462
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Country | US
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Telephone | 561-548-1710
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Fax | 561-548-1743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD305055
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License Number State | GA
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