Healthcare Provider Details

I. General information

NPI: 1356441059
Provider Name (Legal Business Name): YU KANG RD, LIC AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2786 N DECATUR RD STE 220
DECATUR GA
30033-5928
US

IV. Provider business mailing address

487 WINN WAY STE 209
DECATUR GA
30030-1728
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-6284
  • Fax: 404-294-6030
Mailing address:
  • Phone: 404-296-8100
  • Fax: 404-294-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002921
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000102
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: