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General NPI Number Information
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NPI Number | 1447051578
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Entity Type | Individual
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Provider Name | MR. RANDY YOUNG KIM
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Gender | Male
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 665 DULUTH HWY STE 501
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8709
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Country | US
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Telephone | 678-312-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 616 CLEARWATER PARK RD APT 512
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6245
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Country | US
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Telephone | 478-442-2638
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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