Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 039608 | GA |
Y | 207YS0123X | Facial Plastic Surgeon | 039608 | GA |
NPI | 1568469591 |
---|---|
Provider Name | Dr. Kun Zoo Kim |
First Address | Doraville, GA 30340-2699 |
Second Address | Doraville, GA 30340-2699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 28/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000670458F | (05) | GA |
0683598 | CIGNA (01) | GA |
516833 | AETNA (01) | GA |
52498637 | BCBS OF GEORGIA (01) | GA |
G11658 | (02) | GA |