Provider Demographics
NPI:1205092921
Name:KIM, JO MYEONG (DO)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:MYEONG
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2400 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4396
Mailing Address - Country:US
Mailing Address - Phone:770-858-5252
Mailing Address - Fax:770-858-5254
Practice Address - Street 1:2400 PLEASANT HILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4396
Practice Address - Country:US
Practice Address - Phone:770-858-5252
Practice Address - Fax:770-858-5254
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.121020207R00000X
GA64660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109338AMedicaid
GA003109338AMedicaid