Healthcare Provider Details

I. General information

NPI: 1578024386
Provider Name (Legal Business Name): WON JUN KUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 5015
ATLANTA GA
30309-1721
US

IV. Provider business mailing address

95 COLLIER RD NW STE 5015
ATLANTA GA
30309-1721
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number103107
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD93614
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number103107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: