Healthcare Provider Details

I. General information

NPI: 1851376461
Provider Name (Legal Business Name): SANG K PYUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

PO BOX 934370
ATLANTA GA
31193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7111
  • Fax: 205-343-8549
Mailing address:
  • Phone: 800-897-6169
  • Fax: 800-897-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number11256
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: