Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN015106 | GA |
NPI | 1003293077 |
---|---|
Provider Name | Chris Seunghyun Kim |
First Address | Suwanee, GA 30024-3387 |
Second Address | Roswell, GA 30076-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2015 |
Last Update Date | 17/03/2018 |