Individual provider Active NPI

Jina Y. Kim, MD

  • Family Medicine Physician
  • Duluth, GA
National Provider Identifier
1114155702
Registry record updated Dec 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
068656 Issued in GA
Practice address
3610 Peachtree Industrial Blvd
Suite 100
Duluth, GA 30096-4843
Phone
(678) 417-0332
Fax
(678) 417-0313
NPI assigned
Jun 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 068656 GA Primary
Family Medicine Physician 207Q00000X MD31877 SC

Addresses

Primary practice location

3610 Peachtree Industrial Blvd
Suite 100
Duluth, GA 30096-4843

Mailing address

3610 Peachtree Industrial Blvd
Suite 100
Duluth, GA 30096-4843
Phone (678) 417-0332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141217000295 GA Practitioner - Family Practice 6800119272 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
068656GAMDFamily Medicine Physician
MD31877SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Woun Hue Seok DO PC Family Medicine CurrentSince Jul 11, 2014 Accepting new patients

Locations

3500 Duluth Park Ln
Ste 220
Duluth, GA 30096
Phone (678) 417-0332

3610 Peachtree Industrial Blvd
Ste 100
Peachtree Corners, GA 30096
Phone (678) 417-0332

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449878400000",
    "number": "1114155702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964843",
            "telephone_number": "678-417-0332",
            "fax_number": "678-417-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964843",
            "telephone_number": "678-417-0332",
            "fax_number": "678-417-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JINA",
        "middle_name": "Y.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-23",
        "last_updated": "2015-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "068656",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "MD31877",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

Verify at the official NPI Registry.