MEDICARE: DR. SOYUNG KIM O.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	152W00000X	Optometrist	OPT002737	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306849732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOYUNG KIM O.D.

Provider Business Mailing Address
First Line	:	3645 HABERSHAM RD. SUITE 109
Second Line	:	FAMILY EYE CARE CENTER OF ATLANTA
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	713-743-1921
Fax Number	:	713-743-0963

Provider Business Practice Location Address
First Line	:	3645 HABERSHAM RD. SUITE 109
Second Line	:	FAMILY EYE CARE CENTER OF ATLANTA
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-549-9999
Fax Number	:	713-743-0963

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/10/2017

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