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General NPI Number Information
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NPI Number | 1508755778
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Entity Type | Individual
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Provider Name | AUSTIN YUNG KYO KIM
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Gender | Male
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 678-312-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 357 CANTERBURY PLACE DR
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City | SUWANEE
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State | GA
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Zip | 30024-7498
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Country | US
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Telephone | 404-644-4404
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 13315
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License Number State | GA
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