Active NPI
Dong Sun Kim
- Pharmacist
- Marietta, GA
National Provider Identifier
1053725465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH 027309G
- Practice address
- 2200 Roswell Rd
Marietta, GA 30062-2983 - Phone
- (770) 973-7337
- NPI assigned
- Jun 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH 027309G | GA | Primary |
Addresses
Primary practice location
2200 Roswell Rd
Marietta, GA 30062-2983
Mailing address
1340 Walnut Hill Cir
Lawrenceville, GA 30043-8696
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH 027309G | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402617600000",
"number": "1053725465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1340 WALNUT HILL CIR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300438696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 ROSWELL RD",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300622983",
"telephone_number": "770-973-7337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DONG SUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-13",
"last_updated": "2014-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH 027309G",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.