Basic Information
| Provider Information | |||||||||
| NPI: | 1346268497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743904 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743904 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35-065604 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 52502 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 525024 | 05 | SC | MEDICAID | 0968734 | 05 | OH | MEDICAID | 750702 | 01 | OH | BUCKEYE | OTHER | 000000503706 | 01 | ANTHEM | OTHER | 363702 | 01 | OH | WELLCARE | OTHER | 000000221288 | 01 | OH | UNISON | OTHER | P00412262 | 01 | OH | RAILROAD MEDICARE | OTHER | 4459836 | 01 | AETNA | OTHER |