Provider Demographics
NPI:1699160457
Name:KUNIHIRO, SUSAN KIMIKO (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KIMIKO
Last Name:KUNIHIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1821 CLIFTON RD NE STE 1017
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4021
Mailing Address - Country:US
Mailing Address - Phone:404-778-6448
Mailing Address - Fax:404-712-1449
Practice Address - Street 1:1564 CLIFTON RD NE FL 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-778-6448
Practice Address - Fax:404-712-1449
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0057478207Q00000X
GA83270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine