MEDICARE: DR. YEJIN KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	057711	GA

General Provider Information

NPI Number	:	1114089596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YEJIN KIM M.D.

Provider Business Mailing Address
First Line	:	3435 DULUTH PARK LN
Second Line	:	SUITE A
City	:	DULUTH
State	:	GA
Zip	:	30096-3259
Country	:	US
Telephone Number	:	678-417-0407
Fax Number	:	678-417-2008

Provider Business Practice Location Address
First Line	:	3435 DULUTH PARK LN
Second Line	:	SUITE A
City	:	DULUTH
State	:	GA
Zip	:	30096-3259
Country	:	US
Telephone Number	:	678-417-0407
Fax Number	:	678-417-2008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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