Individual
ETHAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 GORDON AVE, THOMASVILLE, GA 31792-6699
(229) 551-2576
(229) 584-7154
Mailing address
1626 PAGE ST, PHILADELPHIA, PA 19121-2320
(267) 247-2896
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/11/2025
Last updated
04/11/2025
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