Provider Demographics
NPI:1578435939
Name:YIM, KYUNGEUN KIM
Entity type:Individual
Prefix:
First Name:KYUNGEUN
Middle Name:KIM
Last Name:YIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 ELVIE WAY
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1816
Mailing Address - Country:US
Mailing Address - Phone:404-988-9253
Mailing Address - Fax:
Practice Address - Street 1:10820 ABBOTTS BRIDGE RD STE 240
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5783
Practice Address - Country:US
Practice Address - Phone:470-223-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist