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NPI Code Detail

MEDICARE: DR. CHANG SOO KIM MD

MEDICARE: DR. CHANG SOO KIM MD
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
1207Q00000XFamily Medicine Physician59806GA

General Provider Information

NPI Number : 1215149554
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHANG SOO KIM MD
Provider Business Mailing Address
First Line : 3590 PEACHTREE INDUSTRIAL BLVD
Second Line :
City : DULUTH
State : GA
Zip : 30096-4817
Country : US
Telephone Number : 770-614-9799
Fax Number : 770-614-9789
Provider Business Practice Location Address
First Line : 3590 PEACHTREE INDUSTRIAL BLVD
Second Line :
City : DULUTH
State : GA
Zip : 30096-4817
Country : US
Telephone Number : 770-614-9799
Fax Number : 770-614-9789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 06/22/2017

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Directions to “ DR. CHANG SOO KIM MD” Practice Location

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