Provider Demographics
NPI:1518011857
Name:KIM, LINDA JONG UN (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JONG UN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LANE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:101 CRYE LEIKE DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4056
Practice Address - Country:US
Practice Address - Phone:706-648-4336
Practice Address - Fax:706-861-4597
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53926207K00000X
GA58890207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13359926EMedicaid
GA132359926DMedicaid