Provider Demographics
NPI:1053578369
Name:KIM, SUNG-OH (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNG-OH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 PEACHTREE PKWY STE L
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1089
Mailing Address - Country:US
Mailing Address - Phone:770-622-2231
Mailing Address - Fax:770-255-1615
Practice Address - Street 1:3651 PEACHTREE PKWY STE L
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1089
Practice Address - Country:US
Practice Address - Phone:770-622-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5404122300000X
GADN013623122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist