MEDICARE: MRS. BETTY HYUNJUNG KIM PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	306836	GA

General Provider Information

NPI Number	:	1205190410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETTY HYUNJUNG KIM PMHNP

Provider Business Mailing Address
First Line	:	801 CASCADE POINTE LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-5823
Country	:	US
Telephone Number	:	213-604-4567
Fax Number	:

Provider Business Practice Location Address
First Line	:	2359 RICHMOND ROW DR
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-7843
Country	:	US
Telephone Number	:	213-604-4567
Fax Number	:	213-604-4567

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

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	05/21/2026

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