Individual
MI HYUN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2765 COLLINS HILL RD, LAWRENCEVILLE, GA 30043
(770) 630-5730
Mailing address
2765 COLLINS HILL RD, LAWRENCEVILLE, GA 30043
(770) 630-5730
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7823
NC
1223G0001X
General Practice Dentistry
Primary
DN013642
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903232
—
NC
01
—
9025Y
BLUE CROSS BLUE SHIELD NC
—
Enumeration date
08/25/2006
Last updated
02/17/2015
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