Provider Demographics
NPI:1194919381
Name:DAVID E KIM MD PC
Entity type:Organization
Organization Name:DAVID E KIM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-923-5049
Mailing Address - Street 1:491 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-3353
Mailing Address - Country:US
Mailing Address - Phone:770-387-4512
Mailing Address - Fax:770-334-3667
Practice Address - Street 1:491 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3353
Practice Address - Country:US
Practice Address - Phone:770-387-4512
Practice Address - Fax:770-334-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3921Medicare PIN