Individual
MR. BEOMJUNE B KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD, FACS
Contact information
Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(770) 400-6000
Mailing address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(770) 400-6000
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
88953
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
34607
OK
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MD.205951
LA
207YS0123X
Facial Plastic Surgery Physician
34607
OK
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
34607
OK
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
88953
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88953
GA MEDICAL LICENSE
GA
Enumeration date
05/07/2008
Last updated
08/24/2021
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