Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5404 | AL |
N | 122300000X | Dentist | DN013623 | GA |
Y | 1223P0700X | Prosthodontist | DN013623 | GA |
NPI | 1053578369 |
---|---|
Provider Name | Dr. Sung-Oh Kim |
First Address | Suwanee, GA 30024-1089 |
Second Address | Suwanee, GA 30024-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 26/07/2021 |