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General NPI Number Information
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NPI Number | 1417649310
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Entity Type | Organization
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Legal Business Name | SUN KIM DMD LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 3100 FIVE FORKS TRICKUM RD SW STE 501
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City | LILBURN
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State | GA
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Zip | 30047-1888
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Country | US
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Telephone | 770-736-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 FIVE FORKS TRICKUM RD SW STE 501
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City | LILBURN
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State | GA
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Zip | 30047-1888
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Country | US
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Telephone | 770-310-2648
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUN KUN KIM
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Credential |
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Telephone | 770-310-2648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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