Provider Demographics
NPI:1215149554
Name:KIM, CHANG SOO (MD)
Entity type:Individual
Prefix:DR
First Name:CHANG SOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3590 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4817
Mailing Address - Country:US
Mailing Address - Phone:770-614-9799
Mailing Address - Fax:770-614-9789
Practice Address - Street 1:3590 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4817
Practice Address - Country:US
Practice Address - Phone:770-614-9799
Practice Address - Fax:770-614-9789
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA59806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine