Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 052762 | GA |
NPI | 1194775254 |
---|---|
Provider Name | Dennis W Kim |
First Address | Atlanta, GA 30341-5510 |
Second Address | Atlanta, GA 30322-1549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 25/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
521781413A | (05) | GA |
H64352 | (02) |