Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006876 | GA |
N | 111NN1001X | Nutrition | GA006876 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | GA006876 | GA |
NPI | 1043403462 |
---|---|
Provider Name | Dr. Sung H Yang |
First Address | Suwanee, GA 30024-2028 |
Second Address | Suwanee, GA 30024-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 19/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
650378 | ACN GROUP, PROVIDER # (01) | GA |
9150110 | PHCS (01) | GA |