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NPI Code Detail

MEDICARE: DR. KENNETH PAK KIM M.D.

MEDICARE: DR. KENNETH PAK 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
1207L00000XAnesthesiology PhysicianMD29309OR
2207L00000XAnesthesiology Physician97909GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00826857OTHERORRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568690832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH PAK KIM M.D.
Provider Business Mailing Address
First Line : 2540 WINDY HILL RD SE
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8605
Country : US
Telephone Number : 470-644-1274
Fax Number : 470-644-1119
Provider Business Practice Location Address
First Line : 2540 WINDY HILL RD SE
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8605
Country : US
Telephone Number : 470-644-1274
Fax Number : 470-644-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 01/11/2026

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