Provider Demographics
NPI:1679786115
Name:KIM, KI CHUN (PHD, LAC)
Entity type:Individual
Prefix:MR
First Name:KI CHUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD. #225
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-417-8838
Mailing Address - Fax:678-417-8756
Practice Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD. #225
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:678-417-8838
Practice Address - Fax:678-417-8756
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000151171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist