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NPI Code Detail

MEDICARE: DR. SUNG KIM O. D.

MEDICARE: DR. SUNG 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
1152W00000XOptometristGA1366GA

Other Identifiers

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

General Provider Information

NPI Number : 1871549733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUNG KIM O. D.
Provider Business Mailing Address
First Line : 546 LAKELAND PLZ
Second Line :
City : CUMMING
State : GA
Zip : 30040-2782
Country : US
Telephone Number : 770-889-2014
Fax Number :
Provider Business Practice Location Address
First Line : 546 LAKELAND PLZ
Second Line :
City : CUMMING
State : GA
Zip : 30040-2782
Country : US
Telephone Number : 770-889-2014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/08/2007

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