Provider Demographics
NPI:1700130143
Name:KIM, TAEHYUNG (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:TAEHYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 TENCH RD
Mailing Address - Street 2:#1211
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6739
Mailing Address - Country:US
Mailing Address - Phone:404-934-0115
Mailing Address - Fax:
Practice Address - Street 1:4485 TENCH RD
Practice Address - Street 2:#1211
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6739
Practice Address - Country:US
Practice Address - Phone:404-934-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist