Provider Demographics
NPI:1538371364
Name:KIM, JAMES SOO (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 LA FRANCE ST NE
Mailing Address - Street 2:UNIT 318
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2163
Mailing Address - Country:US
Mailing Address - Phone:678-879-3538
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:BOX M-7
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-778-6382
Practice Address - Fax:404-778-5495
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98499207R00000X
GA067144208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACF138ZMedicare PIN