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General NPI Number Information
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NPI Number | 1114155702
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Entity Type | Individual
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Provider Name | JINA Y. KIM MD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 12/12/2015
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Provider Practice Location Address
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Address Line | 3610 PEACHTREE INDUSTRIAL BLVD SUITE 100
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City | DULUTH
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State | GA
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Zip | 30096-4843
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Country | US
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Telephone | 678-417-0332
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Fax | 678-417-0313
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Provider Business Mailing Address
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Address Line | 3610 PEACHTREE INDUSTRIAL BLVD SUITE 100
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City | DULUTH
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State | GA
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Zip | 30096-4843
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Country | US
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Telephone | 678-417-0332
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Fax | 678-417-0313
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 068656
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD31877
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License Number State | SC
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