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General NPI Number Information
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NPI Number | 1528378700
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Entity Type | Individual
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Provider Name | JUNGWON KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 350 TOWN CENTER AVE
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City | SUWANEE
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State | GA
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Zip | 30024-6914
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Country | US
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Telephone | 833-210-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 SHENLEY PARK LN
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City | DULUTH
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State | GA
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Zip | 30097-4942
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Country | US
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Telephone | 404-717-9122
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60735298
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12258
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License Number State | GA
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