Provider Demographics
NPI:1194568261
Name:KIM, SUNG H
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 VENTURE DR STE 245
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7162
Mailing Address - Country:US
Mailing Address - Phone:678-602-2270
Mailing Address - Fax:
Practice Address - Street 1:3761 VENTURE DR STE 245
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7162
Practice Address - Country:US
Practice Address - Phone:678-602-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health