Individual provider Active NPI

Dong Sun Kim

  • Pharmacist
  • Marietta, GA
National Provider Identifier
1053725465
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH 027309G Issued in GA
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

Updated by the provider on Jun 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
RPH 027309GGAMDPharmacist

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.

Verify at the official NPI Registry.