| Gwanak Internal Medicine | |
|
3473 Satellite Blvd Ste 108 N Duluth GA 30096-8690 | |
| (770) 864-5510 | |
| (770) 864-5398 |
| Full Name | Gwanak Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 3473 Satellite Blvd, Duluth, Georgia |
| Authorized Official Name and Position | Shawn S Kim (PRESIDENT) |
| Authorized Official Contact | 7708645510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwanak Internal Medicine 3473 Satellite Blvd Ste 108 N Duluth GA 30096-8690 Ph: (770) 864-5510 | Gwanak Internal Medicine 3473 Satellite Blvd Ste 108 N Duluth GA 30096-8690 Ph: (770) 864-5510 |
| NPI Number | 1194088906 |
|---|---|
| Provider Enumeration Date | 06/18/2012 |
| Last Update Date | 06/18/2012 |
| Medicare PECOS PAC ID | 6800031469 |
|---|---|
| Medicare Enrollment ID | O20130402000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194088906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 60393 (Georgia) | Primary |
| Provider Name | Shawn S Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326027715 PECOS PAC ID: 4880661032 Enrollment ID: I20110429000220 |
| Provider Name | Do Hyeon Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710387204 PECOS PAC ID: 2769719277 Enrollment ID: I20190806004335 |
| Provider Name | Ann Jungsun Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275032781 PECOS PAC ID: 6507193679 Enrollment ID: I20190812004028 |
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