Provider Demographics
NPI:1063135135
Name:KIM, KAIZEEN (PAC)
Entity type:Individual
Prefix:
First Name:KAIZEEN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KAIZEEN
Other - Middle Name:MANSOR
Other - Last Name:BADSHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0920
Mailing Address - Country:US
Mailing Address - Phone:404-351-9512
Mailing Address - Fax:404-351-9815
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0920
Practice Address - Country:US
Practice Address - Phone:404-351-9512
Practice Address - Fax:404-351-9815
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant