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General NPI Number Information
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NPI Number | 1063948750
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Entity Type | Organization
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Legal Business Name | JOSEPH J KIM DDS PC
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 2005 BOGGS RD #107
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City | DULUTH
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State | GA
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Zip | 30096-4601
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Country | US
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Telephone | 770-497-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 BOGGS RD #107
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City | DULUTH
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State | GA
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Zip | 30096-4601
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Country | US
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Telephone | 770-497-0885
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOESPH KIM
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Credential | DDS
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Telephone | 770-497-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR005434
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013766
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License Number State | GA
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