Provider Demographics
NPI:1861727802
Name:KIM, ELI YONG (MD)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:YONG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 LITTLE DEBBIE PKWY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4357
Mailing Address - Country:US
Mailing Address - Phone:407-451-6307
Mailing Address - Fax:
Practice Address - Street 1:5545 LITTLE DEBBIE PKWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4357
Practice Address - Country:US
Practice Address - Phone:407-451-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070656207N00000X
TN50377207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology