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General NPI Number Information
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NPI Number | 1760992390
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Entity Type | Individual
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Provider Name | YOONHA KIM
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1712A E BROAD AVE
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City | ALBANY
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State | GA
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Zip | 31705-2611
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Country | US
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Telephone | 229-759-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N WESTOVER BLVD
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City | ALBANY
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State | GA
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Zip | 31707-2983
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Country | US
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Telephone | 229-888-6559
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8528
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License Number State | GA
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